Exhortation to lose weight prior to complex ventral hernia repair: Nudge or noodge?

Background: Exercise and weight loss are recommended for patients with obesity undergoing elective complex ventral hernia repair (cVHR). Methods: Weight and BMI trajectory data on 230 obese patients undergoing cVHR from 2012 to 2017 were retrospectively analyzed from 12 months prior to first visit with the hernia surgeon to 12 months after surgery. Results: One year prior to initial visit, 76 (33%) patients had lost > 1kg/m², 98 (43%) had gained> 1kg/m², and 56 (24%) had no change in body mass index (BMI). Between initial visit and operation, 53 (23%) lost >1kg/m², 43 (19%) gained, and 134 (58%) had no change. Post-operative hyperglycemia was associated with BMI> 40kg/m² at time of operation. Twelve months post-operatively, 69 (35%) had lost >1kg/m², while 52 (26%) had gained, and 108 (47%) had no change. Conclusions: Exhortations for pre-operative and post-operative weight management are not often successful or sustainable, implying a need for individualized holistic approaches.