Surgical Endoscopy

, Volume 31, Issue 3, pp 1311–1317 | Cite as

What is the BMI threshold for open ventral hernia repair?

  • Luise I. M. Pernar
  • Claire H. Pernar
  • Bryan V. Dieffenbach
  • David C. Brooks
  • Douglas S. Smink
  • Ali TavakkoliEmail author



Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase. This study aimed to determine the threshold to allow proper patient counseling.


All patients who underwent open VHR at our institution between 2002 and 2015 captured in the NSQIP database were included. The primary outcome was defined as any (≥1) of 18 captured postoperative complications. Patients were divided into five groups based on BMI: group 1 (<25 kg/m2); 2 (25–29.99 kg/m2); 3 (30–34.99 kg/m2); 4 (35–39.99 kg/m2); and 5 (≥40 kg/m2). Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.


Sixty seven of 922 patients (7.3 %) had at least one postoperative complication following VHR. The adjusted odds of complications in group 5 was 2.89 times greater compared to group 1 (OR 2.89; 95 % CI = 1.22–6.84), while there was no significant differences in odds of postoperative complications for groups 2, 3, or 4 compared to group 1. BMI category was also significantly associated with undergoing recurrent VHR, with 28.7 % of patients in group 5 having a recurrent repair compared to 14 % in patients in group 1 (p = 0.03).


After VHR, complications are most likely to occur in patients with BMI ≥ 40 kg/m2. This subset of patients also had a significantly higher risk of undergoing surgery for a recurrent hernia, suggesting that this group of patients is likely to experience adverse outcomes after VHR and should be counseled to consider bariatric surgery prior to attempts at VHR. VHR at lower BMIs appears appropriate, and delaying therapy to achieve preoperative weight loss will likely offer no advantage.


Hernia Obesity Body mass index Complication 



The authors wish to thank Jill Steinberg for assistance with querying the NSQIP database. Luise I.M. Pernar, MD is supported by the Foundation for Surgical Fellowships.

Compliance with ethical standards


Dr. Tavakkoli receives consulting fees from Medtronic. Drs. Brooks, Dieffenbach, Pernar, Smink, and Mrs. Pernar have nothing to disclose.


  1. 1.
    Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183CrossRefPubMedGoogle Scholar
  2. 2.
    Hruby A, Hu FB (2015) The epidemiology of obesity: a big picture. Pharmacoeconomics 33(7):673–689CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lau B, Kim H, Haigh PI, Tejirian T (2012) Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias. Am Surg 78(10):1118–1121PubMedGoogle Scholar
  4. 4.
    Veljkovic R, Protic M, Gluhovic A, Potic Z, Milosevic Z, Stojadinovic A (2010) Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg 210(2):210–219CrossRefPubMedGoogle Scholar
  5. 5.
    Ooms LS, Verhelst J, Jeekel J, Ijzermans JN, Lange JF, Terkivatan T (2016) Incidence, risk factors, and treatment of incisional hernia after kidney transplantation: an analysis of 1,564 consecutive patients. Surgery. doi: 10.1016/j.surg.2015.11.017 PubMedGoogle Scholar
  6. 6.
    Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8(1):42–46CrossRefPubMedGoogle Scholar
  7. 7.
    Stey AM, Russell MM, Sugar CA, Hall BL, Zingmond DS, Lawson EH et al (2015) Extending the value of the national surgical quality improvement program claims dataset to study long-term outcomes: rate of repeat ventral hernia repair. Surgery 157(6):1157–1165CrossRefPubMedGoogle Scholar
  8. 8.
    Regner JL, Mrdutt MM, Munoz-Maldonado Y (2015) Tailoring surgical approach for elective ventral hernia repair based on obesity and national surgical quality improvement program outcomes. Am J Surg 210(6):1024–1030CrossRefPubMedGoogle Scholar
  9. 9.
    Chan G, Chan CK (2005) A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair. Hernia 9(1):37–41CrossRefPubMedGoogle Scholar
  10. 10.
    Rosen MJ, Aydogdu K, Grafmiller K, Petro CC, Faiman GH, Prabhu A (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19(8):1399–1406CrossRefPubMedGoogle Scholar
  11. 11.
    Look AHEAD Research Group (2014) Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring) 22(1):5–13CrossRefGoogle Scholar
  12. 12.
    Hutchinson C (2016) On the spot with Colleen Hutchinson: the art of herniology. Gen Surg News 22–23Google Scholar
  13. 13.
    Aher CV, Kubasiak JC, Daly SC, Janssen I, Deziel DJ, Millikan KW et al (2015) The utilization of laparoscopy in ventral hernia repair: an update of outcomes analysis using ACS-NSQIP data. Surg Endosc 29(5):1099–1104CrossRefPubMedGoogle Scholar
  14. 14.
    Cobb WS, Kercher KW, Matthews BD, Burns JM, Tinkham NH, Sing RF et al (2006) Laparoscopic ventral hernia repair: a single center experience. Hernia 10(3):236–242CrossRefPubMedGoogle Scholar
  15. 15.
    Nelson JA, Fischer JP, Cleveland EC, Wink JD, Serletti JM, Kovach SJ (2014) Abdominal wall reconstruction in the obese: an assessment of complications from the national surgical quality improvement program datasets. Am J Surg 207(4):467–475CrossRefPubMedGoogle Scholar
  16. 16.
    Qin C, Hackett NJ, Kim JYS (2015) Assessing the safety of outpatient ventral hernia repair: a NSQIP analysis of 7666 patients. Hernia 19(6):919–926CrossRefPubMedGoogle Scholar
  17. 17.
    Desai KA, Razavi SA, Hart AM, Thompson PW, Losken A (2016) The effect of BMI on outcomes following complex abdominal wall reconstructions. Ann Plast Surg. doi: 10.1097/SAP.0000000000000673 PubMedGoogle Scholar
  18. 18.
    Fischer JP, Wink JD, Nelson JA, Kovach SJ (2014) Among 1,706 cases of abdominal wall reconstruction, what factors influence the occurrence of major operative complications? Surgery 155(2):311–319CrossRefPubMedGoogle Scholar
  19. 19.
    Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg 220(4):405–413CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Marx L, Raharimanantsoa M, Mandala S, D’Urso A, Vix M, Mutter D (2014) Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35. Surg Endosc 28(12):3310–3314CrossRefPubMedGoogle Scholar
  21. 21.
    Fekkes JF, Velanovich V (2015) Amelioration of the effects of obesity on short-term postoperative complications of laparoscopic and open ventral hernia repair. Surg Laparosc Endosc Percutan Tech 25(2):151–157CrossRefPubMedGoogle Scholar
  22. 22.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 115(12):956–961 (1991)Google Scholar
  23. 23.
    Schuster R, Curet MJ, Alami RS, Morton JM, Wren SM, Safadi BY (2006) Concurrent gastric bypass and repair of anterior abdominal wall hernias. Obes Surg 16(9):1205–1208CrossRefPubMedGoogle Scholar
  24. 24.
    Newcomb WL, Polhill JL, Chen AY, Kuwada TS, Gersin KS, Getz SB et al (2008) Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia 12(5):465–469CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Luise I. M. Pernar
    • 1
  • Claire H. Pernar
    • 2
  • Bryan V. Dieffenbach
    • 1
  • David C. Brooks
    • 1
  • Douglas S. Smink
    • 1
  • Ali Tavakkoli
    • 1
    Email author
  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA

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