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Randomized Controlled Trials of Weight Loss Before Hernia Surgery: A Systematic Review and Meta-Analysis
Nadia McLurcan1, David L Sanders1, Marianne Hollyman2,3
1Academic Department of Abdominal Wall and Upper Gastrointestinal Surgery, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, United Kingdom.
Journal of Abdominal Wall Surgery : JAWS
|October 29, 2025
Summary
Weight loss interventions before hernia surgery show minimal evidence of effectiveness. More robust trials are needed to determine if pre-operative weight loss improves outcomes for obese patients undergoing hernia repair.
Area of Science:
- Surgical outcomes
- Obesity management
- Evidence synthesis
Background:
- Hernia repairs are common global surgeries.
- Over half of patients in Europe and the US are overweight or obese, making weight a critical factor.
- Pre-operative weight loss is often considered for surgical candidates.
Purpose of the Study:
- To synthesize randomized controlled trial (RCT) evidence on weight loss interventions before hernia surgery.
- To evaluate the impact of these interventions on patient outcomes.
Main Methods:
- Searched PubMed, EMBASE, and CENTRAL databases in April 2025.
- Conducted meta-analysis using random and fixed effects models.
- Assessed bias with Cochrane Rob2 and certainty of effect with GRADE.
Main Results:
- Included 3 RCTs with 219 patients, primarily ventral hernia repair.
- Very low-calorie diets (VLCDs) did not significantly reduce weight or complications.
- Risk of bias was high, and certainty of effect was very low.
Conclusions:
- Evidence supporting pre-operative weight loss interventions for hernia repair is minimal.
- Urgent need for large, robust RCTs to establish efficacy and optimal methods for weight loss before hernia surgery.
