Abstract
Purpose
Obesity is known to result in increased morbidity and risk of hernia recurrence after ventral hernia repair; however, many patients lack the resources to pursue guided weight loss. We sought to evaluate the effectiveness of a free Weight Management Navigator (WMN) program on preoperative weight loss for patients with Class 2 or 3 obesity and complex ventral hernias seeking surgical repair.
Methods
From September 2019 and December 2020, all patients with BMI ≥ 35 kg/m2 and ventral hernias seeking surgical care were identified in outpatient clinics at a high-volume hernia center and were offered participation in a free WMN program by the attending surgeon. Descriptive analysis was performed to analyze participation in the program and average weight loss during study period.
Results
One hundred ninety one patients were identified. Most patients declined to participate in a weight loss program, were unable to be reached, or did not respond to the WMN (58.1%). Eighty patients enrolled in a WMN program, forty-four of which were lost to follow-up (55%). Seventeen patients underwent hernia repair, nine of which were enrolled in a WMN program. Mean weight loss for those enrolled in a program was 5.97 kg compared to 1.8 kg for those who did not participate (p = 0.01).
Conclusion
Enrollment in weight loss programs was low despite encouragement from surgeons, free programs, and accessible platforms. Participation in the WMN correlated with more successful weight loss. Our findings suggest that inability to lose weight may be multifactorial. Further study should be devoted to determining other common barriers to weight loss.
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References
Pernar L, Pernar C, Dieffenbach B et al (2017) What is the BMI threshold for open ventral hernia repair? Surg Endosc 31:1311–1317. https://doi.org/10.1007/s00464-016-5113-5
Tsai AG, Wadden TA (2009) Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med 24(9):1073–1079
Appel LJ, Clark JM, Yeh H-C et al (2011) Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 365:1959–1968. https://doi.org/10.1056/NEJMoa1108660
Chan G, Chan CK (2005) A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair. Hernia 9:37–41. https://doi.org/10.1007/s10029-004-0270-1
Rosen MJ, Aydogdu K, Grafmiller K et al (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19:1399–1406. https://doi.org/10.1007/s11605-015-2856-6)
Flum DR, Horvath K, Koepsell TD (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135. https://doi.org/10.1097/00000658-200301000-00018
Delaney LD, Howard R, Palazzolo K et al (2021) Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients. JAMA Netw Open 4(11):2130016. https://doi.org/10.1001/jamanetworkopen.2021.30016
Liang MK, Bernardi K, Holihan JL et al (2018) Modifying risks in ventral hernia patients with prehabilitation. Ann Surg 268:674–680. https://doi.org/10.1097/SLA.0000000000002961
Funding
Ajita Prabhu, MD discloses a research grant paid to institution and speaking fees from Intuitive Surgical as well as consulting fees from CMR Surgical and Verb Surgical- unrelated to current manuscript. Michael Rosen, MD discloses salary support as Medical Director of Abdominal Core Quality Collaborative and stock options/board member of Ariste Medical- unrelated to current manuscript. Clayton Petro, MD discloses societal grants from Americas Hernia Society, SAGES, and Central Surgical Society- unrelated to current manuscript. Leslie Heinberg, PhD discloses a grant from NIDDK, funding from ASMBS, and position as ASMBS Integrated Health Program Chair- unrelated to current manuscript.
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This study was not funded. Dr. Prabhu discloses receipt of consulting fees from Verb Surgical and CMR Surgical, as well as research support paid to institution and speaking fees from Intuitive Surgical. Dr. Petro discloses receipt of individual grants from SAGES, Americas Hernia Society and Central Hernia Society. Dr. Rosen discloses receipt of salary support as Medical Director of Abdominal Core Quality Collaborative as well as stock options and status as a board member of Ariste Medical.
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Ethical approval was agreed by the ethical committee of the institution.
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This study including human subjects has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.
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Maskal, S.M., Boyd-Tressler, A.M., Heinberg, L.J. et al. Can a free weight management program “move the needle” for obese patients preparing for hernia surgery?: outcomes of a novel pilot program. Hernia 26, 1259–1265 (2022). https://doi.org/10.1007/s10029-022-02625-7
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DOI: https://doi.org/10.1007/s10029-022-02625-7