Radiologic recurrence after minimally invasive ventral hernia repair in patients with class III obesity: a single-center retrospective cohort study
6 affiliations
- 1Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.
- 2Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
- 3Facultad de Medicina y Cirugía, Universidad Católica de Honduras "Nuestra Señora Reina de la Paz", San Pedro Sula, Honduras.
- 4Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Azuay, Ecuador.
- 5Quantitative Biomedical Sciences Doctoral Program, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.
- 6Department of Surgery, Montefiore Medical Center, Bronx, NY, United States.
Abstract
Background: Obesity is a known risk factor for complications and recurrence after ventral hernia repair (VHR). Many surgeons defer elective repair in patients with class III obesity based on body mass index (BMI) thresholds. We evaluated postoperative outcomes and factors associated with recurrence after minimally invasive VHR in this high-risk population.
Methods: This single-center retrospective cohort study included consecutive adult patients with BMI ≥40 kg/m2 who underwent predominantly minimally invasive VHR between January 1, 2012, and December 31, 2024, and had postoperative radiologic follow-up by computed tomography (CT). The primary outcome was radiologic hernia recurrence. Secondary outcomes included 30-day complications and postoperative weight trajectory. Between-group comparisons used Fisher’s exact or χ2 tests for categorical variables and Welch t-test or Mann-Whitney U test for continuous variables, as appropriate; two-sided p < 0.05 was considered significant.
Results: Fifty-two patients (mean BMI 45.0 ± 5.4 kg/m2), 80.8% female, met the inclusion criteria. Radiologic recurrence occurred in 9 patients (17.3%; CI 9.4%–29.7%) at a median imaging follow-up of 793 days (IQR 412–1381) in the overall cohort. Recurrence was observed exclusively in incisional (2/16, 12.5%) or recurrent incisional hernias (7/21, 33.3%) (p = 0.028), with no recurrences in primary hernias (0/15). 30-day complications occurred in 11.5% of patients. Patients with recurrence experienced significantly greater postoperative weight loss than those without (15.6% vs. 4.6% of total body weight; p = 0.015). Operative technique and mesh-related variables were not significantly associated with recurrence (all p > 0.25), although the study was underpowered to detect such associations.
Conclusion: Minimally invasive VHR in patients with class III obesity was associated with low short-term morbidity, but the mid-term radiologic recurrence rate of 17.3% is on the higher end of published estimates and should not be characterized as low. Recurrence occurred exclusively in incisional and recurrent incisional hernias, reaching 24.3% when primary hernias were excluded; associations with technical factors and BMI were not statistically significant in this small sample. Greater postoperative weight loss was associated with recurrence, though reverse causation and ascertainment bias cannot be excluded. Given the small sample size, these findings are hypothesis-generating and warrant confirmation in larger, prospective studies.
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BibTeX
@article{ahmed2026radiologic,
title = {{Radiologic recurrence after minimally invasive ventral hernia repair in patients with class III obesity: a single-center retrospective cohort study}},
author = {Ahsan Ahmed and Faizan Khalid and Ali Sadeghi and Marlon Rodriguez Valladares and Marlen Flores and Valeria Loja Pauta and Cesar Alas-Pineda and Cosman Camilo Mandujano},
journal = {Journal of Abdominal Wall Surgery},
year = {2026},
month = oct,
doi = {10.3389/jaws.2026.17051},
url = {https://doi.org/10.3389/jaws.2026.17051},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Radiologic recurrence after minimally invasive ventral hernia repair in patients with class III obesity: a single-center retrospective cohort study
AU - Ahsan Ahmed
AU - Faizan Khalid
AU - Ali Sadeghi
AU - Marlon Rodriguez Valladares
AU - Marlen Flores
AU - Valeria Loja Pauta
AU - Cesar Alas-Pineda
AU - Cosman Camilo Mandujano
PY - 2026
DA - 2026/10/12
JO - Journal of Abdominal Wall Surgery
DO - 10.3389/jaws.2026.17051
UR - https://doi.org/10.3389/jaws.2026.17051
AB - Background: Obesity is a known risk factor for complications and recurrence after ventral hernia repair (VHR). Many surgeons defer elective repair in patients with class III obesity based on body mass index (BMI) thresholds. We evaluated postoperative outcomes and factors associated with recurrence after minimally invasive VHR in this high-risk population. Methods: This single-center retrospective cohort study included consecutive adult patients with BMI ≥40 kg/m2 who underwent predominantly minimally invasive VHR between January 1, 2012, and December 31, 2024, and had postoperative radiologic follow-up by computed tomography (CT). The primary outcome was radiologic hernia recurrence. Secondary outcomes included 30-day complications and postoperative weight trajectory. Between-group comparisons used Fisher’s exact or χ2 tests for categorical variables and Welch t-test or Mann-Whitney U test for continuous variables, as appropriate; two-sided p < 0.05 was considered significant. Results: Fifty-two patients (mean BMI 45.0 ± 5.4 kg/m2), 80.8% female, met the inclusion criteria. Radiologic recurrence occurred in 9 patients (17.3%; CI 9.4%–29.7%) at a median imaging follow-up of 793 days (IQR 412–1381) in the overall cohort. Recurrence was observed exclusively in incisional (2/16, 12.5%) or recurrent incisional hernias (7/21, 33.3%) (p = 0.028), with no recurrences in primary hernias (0/15). 30-day complications occurred in 11.5% of patients. Patients with recurrence experienced significantly greater postoperative weight loss than those without (15.6% vs. 4.6% of total body weight; p = 0.015). Operative technique and mesh-related variables were not significantly associated with recurrence (all p > 0.25), although the study was underpowered to detect such associations. Conclusion: Minimally invasive VHR in patients with class III obesity was associated with low short-term morbidity, but the mid-term radiologic recurrence rate of 17.3% is on the higher end of published estimates and should not be characterized as low. Recurrence occurred exclusively in incisional and recurrent incisional hernias, reaching 24.3% when primary hernias were excluded; associations with technical factors and BMI were not statistically significant in this small sample. Greater postoperative weight loss was associated with recurrence, though reverse causation and ascertainment bias cannot be excluded. Given the small sample size, these findings are hypothesis-generating and warrant confirmation in larger, prospective studies.
SN - 2813-2092
ER -