Generally it should not be a problem to have a sleeve after incisional hernia repair, even with mesh. You do not need to worry about the insufflation of the abdomen stretching the mesh if you go through palmer's point. All laparoscopic incisions are small and do not disrupt the integrity of the mesh. The only incision that is a little larger is the one that the resected stomach is removed through. Ideally you want to do the sleeve laparoscopically. Yes, there will be a lot of adhesions, but an experienced laparoscopic bariatric surgeon can get it done with the laparoscope. The mesh can be re-sewn and it will heal fine. It is hard to say for sure without knowing where on your abdominal wall the mesh was placed, but I have operated on numerous patients with prior hernia repairs and it isn't a challenge that can't be overcome. If the hernia was from a prior C-section, meaning lower on your abdominal wall, then the laparoscopic port sites for a VSG should not interfere.