Hernia and Obesity, Bariatric Surgery and Hernia Repair?

30 August 2025 –

Ernesto Escobar,MD

Obesity is one of the main risk factors for developing spontaneous (primary) hernias in different areas of the abdomen, particularly in the groin and umbilical region, as well as secondary herniae resulting from surgical procedures, known as incisional hernias.
Hernia repair in obese patients poses a greater challenge for the surgeon, since surgical access to the tissues is more complex. The tension and traction exerted by the weight on the wound edges, combined with the increased pressure of the intra-abdominal organs against the abdominal wall, predispose the hernia to reappear—that is, to “recur” or “relapse”—making it even more complex.

This also highlights that obese patients are more prone to complications following hernia repair surgery, not only at the local level of the surgical wound (tearing/dehiscence, hematomas, infections, or visceral strangulation), but also to medical complications (pneumonia, pulmonary embolism, cardiac problems, and systemic infections). Consequently, there is an ongoing debate within major surgical communities worldwide regarding when and how to operate in the safest and most effective manner on patients suffering from both obesity and herniae.
Multiple published studies address the performance of hernia repair in conjunction with weight-loss (bariatric/metabolic) surgery. While there are indeed successful cases, there are also cases that may present with significant difficulties.

The largest study conducted using the MBSAQIP database (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program of the United States of America) provided information that had not previously been collected in other publications carried out by certain research groups, whether in individual practice or multicenter studies (across different hospitals). The MBSAQIP database offers access to a large number of surgeries performed in obese patients undergoing bariatric surgery in combination with other procedures, such as hernia repair.

In 2020, Clapp and collaborators conducted a review of this database focusing on surgeries performed between 2015 and 2017, of which 5,463 patients underwent bariatric surgery (gastric bypass/sleeve gastrectomy) plus herniae repair. The study demonstrated that in these cases there was a significant increase in operative time and higher complication rates, associated with greater risk of mortality, hospital readmissions, longer hospital stays, and higher costs.

For this reason, surgeons who perform complex hernia surgery* and bariatric surgery clearly understand the concept of patient prehabilitation and abdominal wall prehabilitation. This refers to the attempt to modify or improve the patient’s condition—both in terms of the abdominal wall and overall health status—by reducing or addressing risk factors in order to achieve better outcomes. Although each case is individualized and approached under specific principles, it is important to recognize that any patient with a Body Mass Index (BMI) greater than 35 has an increased risk of complications. For this reason, it is often necessary to consider performing weight-loss surgery first and deferring herniae repair to a subsequent procedure.

*Dr. Ernesto Escobar is a Founding Member of the Herniae Chapter of the Salvadoran Association of General Surgery and a Member of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). As part of his training, he has acquired expertise in implementing prehabilitation strategies for both the patient and the abdominal wall in order to achieve better outcomes.

In summary:

Herniae surgery in obese patients is not recommended as a primary treatment if obesity is not adequately managed.
Performing herniae surgery concomitantly/simultaneously with bariatric surgery increases the risk of medical and surgical complications, which in some cases may be fatal.
Obese patients benefit greatly from addressing obesity first (by whichever method is chosen) and then undergoing herniae repair.

Hernia and Obesity, Bariatric Surgery and Hernia Repair?

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