This video demonstrates laparoscopic sleeve gastrectomy together with hernia repair inpatient of morbid obesity. In morbidly obese patients with any hernia with or without GERD undergoing LSG, repair of the hernia helps in amelioration of morbidity due to hernia and prevents any new onset improving quality of life. Obesity is associated with multiple comorbidities including diabetes mellitus, hypertension, obstructive sleep apnoea and gastro-oesophageal reflux disease (GERD). Thus, the presence of any ventral hernia should not be considered as a contraindication for laparoscopic sleeve gastrectomy surgery and both the procedure can effectively be performed together.

Obesity is a growing global health concern and is frequently associated with abdominal wall hernias, particularly ventral and hiatal hernias. Managing both conditions separately may require multiple surgeries, increasing patient risk and recovery time. Sleeve gastrectomy with concurrent hernia repair has emerged as a safe, effective, and efficient combined surgical approach that addresses obesity and hernia disease in a single operative setting.

Understanding Sleeve Gastrectomy

Sleeve gastrectomy is a popular bariatric procedure that involves removing approximately 75–80% of the stomach, creating a narrow, tube-shaped gastric sleeve. This reduces stomach capacity and decreases hunger by lowering ghrelin hormone levels. The procedure promotes significant weight loss and improvement in obesity-related comorbidities such as type 2 diabetes, hypertension, and sleep apnea.

Hernias in Obese Patients

Obese individuals are at a higher risk of developing abdominal wall hernias due to increased intra-abdominal pressure, weakened musculature, and previous surgical scars. Common hernias encountered in bariatric patients include ventral, incisional, umbilical, and hiatal hernias. If left untreated, hernias may cause pain, bowel obstruction, or strangulation.

Rationale for Combined Surgery

Performing sleeve gastrectomy with hernia repair simultaneously offers several advantages:

• Single anesthesia and hospital admission

• Reduced overall surgical cost

• Faster recovery and earlier return to daily activities

• Prevention of hernia-related complications during rapid postoperative weight loss

Careful patient selection and surgical expertise are essential to ensure safety and optimal outcomes.

Surgical Technique

The combined procedure is usually performed laparoscopically. Sleeve gastrectomy is completed first to reduce intra-abdominal pressure. Hernia repair follows, with the technique depending on hernia size and location. Small hernias may be repaired with primary suturing, while larger defects often require mesh reinforcement. The choice of mesh and fixation method is critical to minimize infection and recurrence.

Safety and Outcomes

Multiple studies have shown that concurrent sleeve gastrectomy and hernia repair is safe when performed by experienced laparoscopic surgeons. Complication rates are comparable to standalone bariatric surgery, with low recurrence of hernia when appropriate repair techniques are used. Patients benefit from sustained weight loss, reduced hernia symptoms, and improved quality of life.

Postoperative Care

Postoperative management includes gradual dietary progression, early mobilization, pain control, and close monitoring for complications such as infection or seroma. Long-term follow-up is essential to assess weight loss, nutritional status, and hernia integrity.

Conclusion

Sleeve gastrectomy with hernia repair is a comprehensive and patient-centered surgical strategy for obese individuals with coexisting hernias. When performed with meticulous technique and proper patient selection, this combined approach offers excellent outcomes, minimizes surgical risk, and enhances overall patient recovery.