Risk Factors for the Development of Incisional Hernia Following Roux-en- Y Gastric Bypass Surgery

Roux-en-y gastric bypass (RYGB) has become the most common operation in the United States for morbid obesity. Even in the laparoscopic era many procedures are still done via laparotomy. Incisional hernias are a complication of any abdominal surgery with obese patients being at increased risk. Patients undergoing open RYGB over 6 years were reviewed to evaluate the risk factors for the development of incisional hernia. 444 adults (88 male, 3566 female) using ASBS and NIH criteria who underwent open RYGB were studied. Patients with asthma and a history of steroid use were all off steroids for at least 6 months prior to surgery. Lesser curvature RYGB was performed through a 10-14 cm upper abdominal incision. The linea alba was closed using running 1-0 polydiaxone sulfate (PDS) sutures. The mean follow up was 2 years. The incidence of incisional hernia was 18.7%, based upon post-operative office follow-up and/or CT scan. Overall, 130 (29.3%) required post-operative local wound care for drainage, 44 (33.8%) of which developed incisional hernias. 93 (23.3%) had a past medical history that included asthma, 32 (34.4%) of which developed incisional hernias. There was a statistically significant association between a history of asthma and post-operative wound infection with the development of incisional hernia. In this study, other variables, such as gender, prior incisional hernia repair, prior abdominal surgery, pre-operative BMI, history of smoking, diabetes,%EWL and post-operative pneumonia were not found to be associated with incisional hernia. Measures to minimize post-operative wound infection or excessive coughing in patients with asthma may reduce the incidence of incisional hernia following RYGB.