Víctor Rodrigues-Gonçalves, Mireia Verdaguer-Tremolosa, Pilar Martínez-López, Clara Nieto, Sana Khan, Manuel López-Cano
{"title":"腹疝以肥胖为中心的康复策略：队列研究。","authors":"Víctor Rodrigues-Gonçalves, Mireia Verdaguer-Tremolosa, Pilar Martínez-López, Clara Nieto, Sana Khan, Manuel López-Cano","doi":"10.1007/s10029-025-03392-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"202"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158845/pdf/","citationCount":"0","resultStr":"{\"title\":\"Obesity-focused prehabilitation strategies in ventral hernia: Cohort study.\",\"authors\":\"Víctor Rodrigues-Gonçalves, Mireia Verdaguer-Tremolosa, Pilar Martínez-López, Clara Nieto, Sana Khan, Manuel López-Cano\",\"doi\":\"10.1007/s10029-025-03392-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":13168,\"journal\":{\"name\":\"Hernia\",\"volume\":\"29 1\",\"pages\":\"202\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158845/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hernia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10029-025-03392-x\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-025-03392-x","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Obesity-focused prehabilitation strategies in ventral hernia: Cohort study.
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.
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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