Neoadjuvant Glucagon-Like Peptide-1 Receptor Agonists in Abdominal Wall Hernia Surgery: A Narrative Review

Glucagon-like peptide-1 (GLP-1) receptor agonist medications are revolutionizing approaches to weight loss, including in the neoadjuvant setting. Obesity poses a challenge to the hernia surgeon, as an independent modifiable risk factor for hernia occurrence which also connotates a higher risk of post-operative morbidity, complications, and recurrence. This is the first review to investigate the neoadjuvant potential of GLP-1 receptor agonists to result in weight loss prior to elective abdominal wall hernia surgery in obese patients.

A computer-assisted search of Medline, PubMed, and EMBASE was conducted to identify studies reporting on the utility of GLP-1 receptor agonist medications in neoadjuvant weight loss prior to abdominal wall hernia surgery.

A total of three retrospective studies were included in this narrative study. In this study, GLP-1 receptor agonists have been found to contribute to either statistically significantly greater weight loss and BMI reductions, or at least equivalent outcomes, in the pre-operative setting prior to elective abdominal wall hernia repair, when compared to conventional lifestyle modifications alone. However, neoadjuvant GLP-1 receptor agonists have not been shown to be superior to pre-operative bariatric surgery in effecting weight loss and BMI reduction. GLP-1 receptor agonists have also been found to be associated with an earlier surgery date if weight loss is the barrier to surgery, when compared to both lifestyle modifications and bariatric surgery. Crucially, GLP-1 receptor agonists have not been shown to lead to more complications or hernia recurrences in terms of post-operative outcomes. These results are limited by the relative paucity of data, the heterogeneity of the included studies, and the absence of long-term outcomes.

There may be a promising role for GLP-1 receptor agonists in the neoadjuvant approach to abdominal wall hernia repair, by inducing and accelerating pre-operative weight loss without a negative impact on post-operative outcomes. Only limited conclusions can yet be drawn at this stage and large-scale prospective studies, ideally in a randomized controlled setting, are necessary to investigate this finding further.