What is the association between BMI classes and the outcome in incisional hernia repair?

The percentage of people who are overweight or obese is increasing worldwide. Already today, almost three billion out of 8.2 billion people are overweight. Patients with overweight or obesity are at a higher risk of developing incisional hernias following abdominal procedures. Registry data on open ventral hernia repair reveal rates of 58.5% in the presence of obesity. There are very few studies on the outcome of incisional hernia repair in relation to BMI classes.

In a retrospective study of data on incisional hernias in the Herniamed Registry, multivariable analysis of potential confounding factors on the outcome was carried out. The prime focus was on the association of BMI classes, as defined by WHO.

Following patient selection, 42,081 patients were included in the analysis (normal weight: 22.9%; overweight: 38.5%, and obesity: 38.5%). No association was found between the outcome and the BMI classes with regard to the intraoperative complications, general complications or chronic pain requiring treatment. An unfavorable relationship was identified between higher BMI classes and the postoperative complications, complication-related reoperations and recurrences. A favorable relationship was seen between higher BMI classes and chronic pain at rest and on exertion.

Since higher BMI classes have a very negative association with the outcome in incisional hernia repair with regard to postoperative complications, complication-related reoperations and recurrence, preoperative weight loss seems to be an important measure to avoid complications and recurrences.