Surgical Treatment of Complex Abdominal Wall Hernia in Obese Patients

Abstract Background Obesity is considered a factor contributing to the complexity of abdominal wall hernias due to an increased risk of surgical wound complications, intra-abdominal pressure and recurrence. The risks associated with obesity significantly escalate when the body mass index (BMI) is greater than 30 kg/m2. The optimal approach for managing these patients remains unclear. Our objective is to assess outcomes in the surgical treatment of complex abdominal wall hernias in obese patients. Method Retrospective analysis of 13 patients who underwent surgery for complex abdominal wall hernias after participating in a pre-operative program for both surgical and non-surgical weight loss. Patients with a BMI 35 were included. Results The average initial BMI was 40 kg/m2 (39–47), and the preoperative BMI was 30 kg/m2 (21–36). Among the patients, six underwent bariatric surgery for the first time (four vertical gastrectomies, one Roux Y Gastric Bypass, and one SADI-S). For those included in the non-surgical weight loss protocol, all were supervised by a nutritionist and endocrinologist, and three of them underwent intragastric balloon placement. The complication rate was 23%, with two cases of wound dehiscence without infection and one case of hemorrhage requiring percutaneous embolization. Conclusions Primary surgical treatment of obesity is favored when indicated. Non-surgical weight loss program (including diet, medications, or intragastric balloon) with synchronous bariatric surgery should be reserved for patients unable to undergo primary surgery or those requiring rapid correction of abdominal wall defects. The pre-operative preparation process is gradual, and currently, numerous individuals are in the preparatory phase.