Modifying Risks in Ventral Hernia Patients With Prehabilitation: A Randomized Controlled Trial

Ann Surg. 2018 Oct;268(4):674-680. doi: 10.1097/SLA.0000000000002961.


Objective: The aim of this study was to determine whether preoperative nutritional counseling and exercise (prehabilitation) in obese patients with ventral hernia repair (VHR) results in more hernia-free and complication-free patients.

Background: Obesity and poor fitness are associated with complications following VHR. These issues are prevalent in low socioeconomic status patients.

Methods: This was a blinded, randomized controlled trial at a safety-net academic institution. Obese patients (BMI 30 to 40) seeking VHR were randomized to prehabilitation versus standard counseling. VHR was performed once preoperative requirements were met: 7% total body weight loss or 6 months of counseling and no weight gain. Primary outcome was the proportion of hernia-free and complication-free patients. Secondary outcomes were wound complications at 1 month postoperative and weight loss measures. Univariate analysis was performed.

Results: Among 118 randomized patients, prehabilitation was associated with a higher percentage of patients who lost weight and achieved weight loss goals; however, prehabilitation was also associated with a higher dropout rate and need for emergent repair. VHR was performed in 44 prehabilitation and 34 standard counseling patients. There was a trend toward less wound complication in prehabilitation patients (6.8% vs 17.6%, P = 0.167). The prehabilitation group was more likely to be hernia-free and complication-free (69.5% vs 47.5%, P = 0.015).

Conclusions: It is feasible to implement a prehabilitation program for obese patients at a safety-net hospital. Prehabilitation patients have a higher likelihood of being hernia-free and complication-free postoperatively. Although further trials and long-term outcomes are needed, prehabilitation may benefit obese surgical patients, but there may be increased risks of dropout and emergent repair.

Clinical trial registration: This trial was registered with (NCT02365194).

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Counseling*
  • Exercise*
  • Female
  • Hernia, Ventral / surgery*
  • Herniorrhaphy
  • Humans
  • Male
  • Middle Aged
  • Nutrition Assessment*
  • Obesity / complications*
  • Patient Compliance
  • Postoperative Complications / prevention & control*
  • Preoperative Care*
  • Safety-net Providers

Associated data