Weight Loss Before Complex Ventral Hernia Repair: Is It Sustainable?

Abstract

Motivation of patients to lose weight is a principal concern in preoperative preparation of patients for complex ventral hernia repair (cVHR). Weight changes following cVHR, however, are not well characterized. In this study, we explored 3 questions: 1) is preoperative weight loss sustainable after operation, 2) can patients unable to lose weight preoperatively initiate weight loss after cVHR, and 3) are there clinical factors that predict postoperative weight change? We performed a retrospective medical record review of patients who underwent open cVHR at an academic tertiary referral center from January 2013 through August 2015. Exclusions were inflammatory bowel disease, metastatic cancer, and bariatric operation specifically in anticipation of cVHR. There were 112 patients included with the following profile: average age 58.4 ± 11.2 years, 84.8% with operative BMI ≥ 30 kg/m2, 29.5% Ventral Hernia Working Group Grade ≥ 3. Sixty-three (56.3%) patients lost weight preoperatively; of these, 57.1% had gained weight 1 year after cVHR. Forty-nine (43.0%) patients gained weight preoperatively; 42.9% of these lost weight postoperatively. No risk factors were identified that predict a high likelihood of pre- or postoperative weight loss. Despite success in promoting weight loss prior to surgery, a high rate of recidivism to weight gain occurs postoperatively. Further, in those patients unable to lose weight preoperatively, cVHR did prompt weight loss in a minority of patients. Together, these findings emphasize the importance of developing weight reduction programs for cVHR patients that not only optimize preoperative conditions but that are also sustainable.