Abstract
PURPOSE: Obesity increases the risk of complications and technical difficulty in ventral hernia repair. Preoperative weight loss is recommended to mitigate these risks, but the implementation of different strategies in routine practice remains poorly described. This study aimed to characterize the use of dietary counseling, pharmacotherapy, and bariatric surgery within a structured optimization pathway and provide preliminary insights into surgical outcomes in obese versus non-obese patients. METHODS: In this retrospective, single-center study, obese patients with ventral hernia were managed with dietary counseling, pharmacotherapy, or bariatric surgery between April 2018 and April 2023. We evaluated implementation, weight loss achieved, eligibility for elective repair, and adherence. Surgical outcomes were descriptively analyzed in obese patients with and without preoperative weight loss and compared to non-obese patients. RESULTS: Of 175 obese patients, 148 (84.6%) received dietary counseling, 15 (8.6%) pharmacotherapy, and 12 (6.8%) bariatric surgery. Median weight loss was highest after bariatric surgery (20.7%), followed by dietary counseling (4.6%) and pharmacotherapy (4.4%). Surgical eligibility rates were 83%, 44%, and 13%, respectively. Among 165 patients who underwent hernia repair, postoperative complications were more frequent in obese patients, regardless of preoperative weight loss, than in non-obese patients. Recurrence was numerically higher in patients without preoperative weight loss, though not statistically significant. CONCLUSION: A structured optimization pathway facilitated the use of diverse weight loss strategies before hernia repair in obese patients. Bariatric surgery achieved the greatest weight loss and eligibility. However, complications remained common, underscoring the need for individualized, multidisciplinary prehabilitation strategies.