Rodrigues-Gonçalves Víctor, Verdaguer-Tremolosa Mireia, Martínez-López Pilar, Nieto Clara, Khan Sana, López-Cano Manuel
General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain.
Hernia. 2025 Jun 11;29(1):202. doi: 10.1007/s10029-025-03392-x.
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.
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.
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.
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.
肥胖会增加腹疝修补术的并发症风险和技术难度。建议术前减重以降低这些风险，但常规实践中不同策略的实施情况仍鲜有描述。本研究旨在描述在结构化优化路径中饮食咨询、药物治疗和减重手术的使用情况，并初步探讨肥胖与非肥胖患者的手术结局。
在这项回顾性单中心研究中，2018年4月至2023年4月期间，对腹疝肥胖患者采用饮食咨询、药物治疗或减重手术进行管理。我们评估了实施情况、减重效果、择期修复的 eligibility 和依从性。对有或无术前减重的肥胖患者的手术结局进行描述性分析，并与非肥胖患者进行比较。
在175例肥胖患者中，148例（84.6%）接受了饮食咨询，15例（8.6%）接受了药物治疗，12例（6.8%）接受了减重手术。减重中位数在减重手术后最高（20.7%），其次是饮食咨询（4.6%）和药物治疗（4.4%）。手术 eligibility 率分别为83%、44%和13%。在165例行疝修补术的患者中，无论术前是否减重，肥胖患者术后并发症均比非肥胖患者更常见。术前未减重患者的复发率在数值上更高，尽管无统计学意义。
结构化优化路径有助于在肥胖患者疝修补术前使用多种减重策略。减重手术实现了最大程度的减重和 eligibility。然而，并发症仍然很常见，这凸显了个性化多学科术前康复策略的必要性。
