Risks and benefits of delaying hernia repair in patients with obesity: a retrospective case series of emergent hernia cases.

Background: Emergent abdominal wall hernia repair is associated with higher rates of morbidity and mortality compared to elective repair. Patients with significant medical comorbidities, such as morbid obesity, experience higher rates of surgical site complications and hernia recurrence. Experts recommend pre-operative optimization to minimize complication risks; however, few guidelines exist for balancing optimization with the risks of a potential emergent operation. We sought to delineate the outcomes of patients who underwent urgent hernia repair at our center with specific attention to those who attempted pre-operative optimization.

Methods: We performed a retrospective chart review of all patients who required emergent or urgent abdominal wall hernia repair with the division of Minimally Invasive Surgery, as identified through emergent or urgent case requests submitted at our tertiary academic medical center from 2018 to 2023. We utilized descriptive statistics to characterize patient demographics, hernia characteristics, prior medical history, operative details, and post-operative outcomes.

Results: Of the 58 total patients enrolled, we noted multiple operative risk factors including advanced age (62 years ± 14.5), high BMI (32.9 kg/m²), numerous medical comorbidities, and high rates of incisional hernias. 20 (34%) patients were previously evaluated in our MIS clinic prior to their urgent repair, and 12 (60%) of these patients had surgery deferred for excess weight. Some patients attended multiple clinic visits, but there were no significant trends between the number of prior visits and weight change. 37 (64%) patients did not receive definitive mesh repair. Of these, 20 (54%) cases cited concern for a contaminated field. Of the total group, 16 (33%) patients ultimately developed a recurrent hernia, including 3 patients who underwent a mesh repair and 13 patients who did not receive a mesh repair.

Conclusion: The timing of an abdominal wall hernia repair remains challenging, particularly in patients with morbid obesity. For these high-risk patients, recognizing decreasing gains in pre-operative weight optimization is a key for avoiding unproductive delays of definitive repair.