Episode 12 - "Complex Hernias + Severe Obesity: The Perfect Surgical Storm"
Update: 2025-05-31
Description
🎙️ Episode Title:
Episode 12 - "Complex Hernias + Severe Obesity: The Perfect Surgical Storm"
📝 Episode Description:
In this episode of the Master General Surgery – Abdominal Wall Series, we review the pivotal 2025 study published in Hernia on the feasibility and safety of Laparoscopic Sleeve Gastrectomy (LSG) as the first step in a staged approach for patients with severe obesity and complex abdominal wall hernias (CAWH) with loss of domain (LOD). While LSG proved feasible and safe with no intraoperative complications or mortality, the study reported a higher-than-expected major complication rate (18.75%), underscoring the technical complexity of these cases. We examine the rationale behind staging, the role of abdominal imaging in surgical planning, and why these patients should only be managed in specialized centers.
Reference:
Dantas, A.C.B., Pajecki, D., Murakami, A.H.F. et al. Feasibility of laparoscopic sleeve gastrectomy in patients with severe obesity and complex abdominal wall hernias with loss of domain. Hernia 29, 170 (2025).
https://doi.org/10.1007/s10029-025-03380-1
🔍 Key topics discussed:
• LSG is feasible and safe, but not risk-free in LOD scenarios
• Surgical planning must include CT-based volume analysis
• Staged approach aligns with ASMBS/IFSO 2022 guidelines
• Outcomes depend on expert teams and patient selection
• Future research should refine pre-op strategies and assess GLP-1 therapy roles
📡 Listen now on all major platforms and in the Google Classroom of the Abdominal Wall and Content Group – Hospital das Clínicas, University of São Paulo.
Episode 12 - "Complex Hernias + Severe Obesity: The Perfect Surgical Storm"
📝 Episode Description:
In this episode of the Master General Surgery – Abdominal Wall Series, we review the pivotal 2025 study published in Hernia on the feasibility and safety of Laparoscopic Sleeve Gastrectomy (LSG) as the first step in a staged approach for patients with severe obesity and complex abdominal wall hernias (CAWH) with loss of domain (LOD). While LSG proved feasible and safe with no intraoperative complications or mortality, the study reported a higher-than-expected major complication rate (18.75%), underscoring the technical complexity of these cases. We examine the rationale behind staging, the role of abdominal imaging in surgical planning, and why these patients should only be managed in specialized centers.
Reference:
Dantas, A.C.B., Pajecki, D., Murakami, A.H.F. et al. Feasibility of laparoscopic sleeve gastrectomy in patients with severe obesity and complex abdominal wall hernias with loss of domain. Hernia 29, 170 (2025).
https://doi.org/10.1007/s10029-025-03380-1
🔍 Key topics discussed:
- Volume ratios (Tanaka/Sabbagh) in LOD assessment
- Surgical risks vs. benefits in high-complexity CAWH
- Preoperative imaging and planning
- Use of LSG as neoadjuvant strategy before hernia repair
- Importance of multidisciplinary teams and surgical expertise
• LSG is feasible and safe, but not risk-free in LOD scenarios
• Surgical planning must include CT-based volume analysis
• Staged approach aligns with ASMBS/IFSO 2022 guidelines
• Outcomes depend on expert teams and patient selection
• Future research should refine pre-op strategies and assess GLP-1 therapy roles
📡 Listen now on all major platforms and in the Google Classroom of the Abdominal Wall and Content Group – Hospital das Clínicas, University of São Paulo.
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