Ventral Hernia Repair in the Morbidly Obese Patient: A Review of Medical and Surgical Approaches in the Literature

Abstract

Background:

Obesity is a risk factor for ventral hernias. As obesity becomes more prevalent, general surgeons will be faced with managing complex ventral hernias in the obese. Consensus is that weight loss improves outcomes in obese patients undergoing ventral hernia repair (VHR), but there is no agreement on the best approach.

Methods:

We conducted a literature search using EMBASE and Medline using the terms “hernia,” “morbid,” and “obesity.” We identified studies discussing the medical or surgical management of obesity with VHR. We assimilated the data into a literature review discussing management options for ventral hernia in the obese patient.

Results:

Fourteen articles were utilized in this review. Hernia repair preceded by physician monitored medical weight loss, concomitant hernia repair with weight loss surgery, or weight loss surgery staged prior to or after hernia repair were all viable options to approach this problem. However, there are limited level 1 data to address this problem.

Conclusions:

The data suggest that medical or surgical approaches to weight loss along with VHR are feasible options. The choice depends upon many factors involving the surgeon, patient, and institution. There is limited level 1 evidence as to the best approach or standard of care.