Obese patients are at a high risk of hernia recurrence: Says expert

Hernia recurrence is more likely due to a high pressure exerted on the abdominal wall

Obesity is one of the major problems in India. It is estimated that prevalence of obesity in India will triple over the period 2010 to 2040, while the population of overweight adults (20-69 years of age) will more than double during this period.¹ Obesity brings with it other disorders called co-morbidities like diabetes, hypertension, cardiovascular diseases, joint issues etc. Hernia recurrence is more likely in obese patients ². In fact, obese people are not only at a higher risk of hernia formation but failure of hernia surgery among such patients is high. To lessen this risk, overweight or obese patients are often asked to lose weight before undergoing a hernia surgery. However, that’s a difficult proposition and is easier said than done.

Dr Vikas Singhal Senior Consultant, Medanta Medicity  Hospital – Gurugram, said, “Bariatric surgery is a type of surgery which not only helps to reduce a significant amount of weight but patients usually get complete remission of co-morbid problems such as Diabetes and Hypertension, lowering the risk of heart disease, cancers etc, and an improvement in the quality of life.”

“Abdominal wall hernia cannot be treated by any drug – it requires surgery. In a few cases, the hernia can come back even after surgery in the patient. Obese patients are at a high risk of hernia recurrence due to a high pressure exerted on the abdominal wall³. The hernia surgery in obese patients also carries an increased risk of wound complications⁴.

Patients suffering from obesity may also often be diabetic, and suffer from joint pains limiting their movement. Thus, they get into a vicious cycle that makes it very difficult to lose weight on their own with just diet and exercise. Hence, Bariatric surgery becomes an important consideration for these patients to help lose weight, reduce complications and reduce the risk of hernia recurrence after surgery. Except in emergency cases for hernia complications, Bariatric surgery becomes a near-necessity in such patients.” added Dr Singhal.

Referring to one of the patient cases, Dr Singhal said, “An individual aged 51 years was suffering from both Obesity and Hernia. He had gained significant weight (was 138 kg) and turned diabetic and also developed a large incisional hernia after his liver transplant surgery. The patient underwent Laparoscopic Sleeve Gastrectomy following which he lost 28 kg weight; his diabetes too was cured. He underwent open incisional hernia surgery and was discharged without any perioperative complications.”

“In another case, an individual aged 44, was suffering from a painfully large recurrent incisional hernia below the navel following hysterectomy surgery. Weighing 108 kg with Body Mass Index (BMI) of 48 a CT scan performed on the patient showed a large 5×5 cm hernia containing multiple loops of small intestine. As the patient was quite symptomatic from the hernia, the hernia repair could not be deferred till after weight loss. Post-surgery, the patient was discharged uneventfully and returned after 2 weeks for removal of sutures and diet advancement, having already lost 8 kg weight”, added Dr Singhal.

Obesity and hernia are common problems which are often associated with one another and compound the problem for the patient. Ultimately, the decision of what is the best solution for this complex problem will need to be individualized for every patient. Those patients needing to undergo this treatment, will need a thorough evaluation, and would need to be well enrolled in a proper plan of care.

References

1. Luhar S, Timæus IM, Jones R, Cunningham S, Patel SA, Kinra S, Clarke L, Houben R.  Forecasting the prevalence of overweight and obesity in India to 2040. PLoS One. 2020 Feb 24; 15(2):e0229438. Doi: 10.1371/journal.pone.0229438. PMID: 32092114; PMCID:  PMC7039458.
2. Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia. 2004 Feb; 8(1):42-6. Doi: 10.1007/s10029-003-0161-x. Epub 2003 Sep 6. PMID: 13680307.
3. Giordano SA, Garvey PB, Baumann DP, Liu J, Butler CE. The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study. Plast Reconstr Surg. 2017; 139(5):1234-1244. doi:10.1097/PRS.0000000000003264
4. Patrick Hamid Alizai, Anne Andert, Eric Lelaona, Ulf Peter Neumann, Christian Daniel Klink, Marc Jansen, Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair – A prospective cohort study, International Journal of Surgery, Volume 48, 2017, Pages 220-224, ISSN 1743-9191, https://doi.org/10.1016/j.ijsu.2017.11.006.