The new bridge to hernia surgery: achieving preoperative weight optimization with GLP-1 receptor agonists for abdominal wall hernia repair

Abstract

Background: Obesity is a risk factor for complications after abdominal hernia repair. Glucagon-like-peptide-1 (GLP-1) receptor agonists are effective weight loss medications that may help patients reach weight loss goals for surgery. In this study, we examine our outcomes utilizing GLP-1 agonists for preoperative weight loss in obese patients undergoing elective hernia repair. Methods: A retrospective review identified obese patients who were prescribed GLP-1 agonists for weight loss in addition to lifestyle changes before elective hernia repair from 2021 to 2024. Patients were managed by a multidisciplinary team and asked to achieve a body mass index (BMI) ≤ 33 kg/m2 before surgery. Primary outcomes were preoperative mean percentage total weight loss (%TWL), mean BMI reduction, and time from GLP-1 agonist initiation to surgery. Secondary outcomes were 30-day morbidity and 30-day reoperation rates, hernia recurrence, and postoperative weight changes. Results: A total of 70 patients with ventral/incisional, umbilical, parastomal, flank, and inguinal hernias were identified. 33 patients (47.1%) underwent surgery, 24 (34.3%) remain in active follow-up, and 13 (18.6%) were lost to follow-up (no clinic visit in 1 year). For patients who underwent surgery, mean BMI on initial presentation was 37.4 ± 4.8 kg/m2. After initiating GLP-1 therapy, mean preoperative %TWL was 14.0 ± 6.9%. Mean preoperative BMI reduction was 5.3 ± 3.5 kg/m2, resulting in mean BMI at surgery of 32.0 ± 3.6 kg/m2. Mean time from GLP-1 agonist initiation to surgery was 8.2 ± 4.9 months. Patients available for 6-month postoperative follow-up (N = 7) maintained their preoperative weight loss (mean surgery BMI: 29.0 ± 2.8 kg/m2 vs. mean BMI at 6 months: 28.5 ± 3.4 kg/m2, p = 0.46). 30-day morbidity and reoperation rates were 9.1% and 6.1%, respectively. Hernia recurrence rate was 3.0% (N = 1) during a mean follow-up of 5.9 ± 12.1 months. Conclusion: GLP-1 receptor agonists can facilitate expeditious and durable preoperative weight loss for patients with obesity prior to elective abdominal wall hernia repair with low postoperative morbidity.