Ventral hernias are umbilical & epigastric hernias.

Incisional hernias arise from prior surgical incisions. 

Though many reasons for the development of ventral hernias nutrition remains the main contributor development of ventral hernias.

Obese patients with metabolic syndrome have several conditions that contribute to an increase in poor post-operative outcomes- arterial hypertension, diabetes cardiac disease, NASH, sarcopenia ETC.

When we are obese with a BMI of more than 30, the chances of developing a hernia doubles.

Also measurements like abdominal wall circumference (female -88 cm and males >102 cm ) correlate with increased fat distribution around the abdomen and increased risk of metabolic syndrome. Finally, obesity masks sarcopenia and sarcopenia is responsible for increased rates of recurrence of hernias.

In patients with a BMI Between 30 to 50,   preoperative weight loss should be a strategic goal to improve outcomes, since weight loss always reduces fat deposition in both the subcutaneous and viscera-compartment.

Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Treatment strategies for ventral hernia with obesity:-

Treatment strategies for ventral hernia with obesity:-

A . Elective hernia repair without previous weight loss.

Whenever ever hernia is diagnosed in an obese patient, the multi-disciplinary team should evaluate the case. If we have to operate hernia in an emergency, then also patient should also be viewed holistically. Sometimes the period of weight loss is deemed too high and hernia repair without prior weight loss may be appropriate. Some patients do not want to reduce weight and want hernia surgery done.

Laparoscopic hernia repair with mesh implantation can be done with a small hernia < 5 cm in diameter is recommended.

For patients with BMI 30-40  with conventional laparoscopic technique hernia content is reduced, preperitoneal fat detached, and mesh implanted (IPOM) intraperitoneally. You can implant mesh extra tonally with ROBOTIC technology.

(B) COMBINED HERNIA REPAIR AND BARIATRIC SURGERY PROCEDURE 

Combined hernia repair and Bariatric surgery give good results with IPOM

(C) Bariatric surgery before hernia repair

Weight loss before elective hernia repair surgery offers the best results as co-morbid conditions like blood sugar, and NAFLD are controlled belter.

Dr Ashish Vashistha, the BEST HERNIA SURGEON IN DELHI  says that Laparoscopic / Robotic mesh repair is a very good option. Hernia repair should be post-phoned till catabolic   phase of weight loss is over.