To the Editor:
LLujan et al,1 in their interesting study, have compared the results of laparoscopic (LapRGB) and open Roux-en-Y gastric bypass (RYGB). The number of arguments supporting the choice of LapRGB as a safer and less invasive method is gradually rising, but the open approach in bariatric surgery is still widely used. One of the obvious disadvantages of open procedure is an unacceptable rate of incisional hernia, having been reported as high as 25%.2 Results of the Spanish study analyzing the complications of vertical band gastroplasty (VBG) in super obese patients showed even higher numbers.3
We published the preliminary report on prophylactic use of polypropylene mesh in wound closure in RYGB surgery.4 Until now, none of 12 reported patients with abdominal wall reinforced with the mesh developed incisional hernia. The mean BMI in this group was 52.9 ± 6.1 kg/m2, and they were followed up for 24 to 60 months. Since the publication, we have used the mesh in more than 20 morbidly obese patients (mean BMI 54.6 ± 7.2 kg/m2), with similar good results.5
The demand for bariatric surgery is still growing6 as at present it is regarded as the most effective way of reducing and maintaining the body weight in the morbidly obese person.7 The prophylactic use of polypropylene mesh in abdominal surgery as a solution for incisional hernia is gaining popularity. This method can be safely applied in those surgical operations which are encumbered with the high rate of incisional hernia (eg, abdominal aorta aneurysm repair8 or cancer surgery in the elderly9). The presence of open gut is not a contraindication to the prophylactic mesh use. A recently published Swedish study showed very good results of this technique as a prevention of parastomal hernia.10
In summary, we believe that the rule “prevention is better than treatment” can be applied in the field of gastric bypass surgery, too. Laparoscopy is obviously the ultimate method of reduction of the incidence of abdominal wall hernia. However, for various reasons the large number of patients still undergoes open abdominal surgery. Until now, it seemed that the postoperative hernia was an unavoidable complication for a substantial number of morbidly obese individuals. The introduction of a new application of a polypropylene mesh can substantially change this situation.
Janusz Strzelczyk, MD, PhD
Department of General and Transplant SurgeryBarlicki University HospitalKopcinskiego, Polandjanuszst@toya.net.pl
Leszek Czupryniak, MD, PhD
Department of Diabetology and Metabolic DisordersBarlicki Unversity HospitalKopcinskiego, Poland
REFERENCES
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