Why does weight loss improve hernia surgery recovery?

ur weight plays an important role both in developing hernias and in developing recurrent hernias after surgery.

It is really all about pressure and tension.

Think of a suitcase. Have you ever packed your suitcase so tight you had to sit on it to close the zipper? Remember wondering if the zipper stitching was going to rip? That is pressure inside the suitcase and tension on the zipper. The more stuff we have in our abdomen, the more pressure we have in our abdomen and the greater the tension it applies to the abdominal wall. If we have a tiny opening somewhere, like at the umbilicus, it can get bigger. If we must have an operation and are sewn back together, it can open up. Sometimes the stuff in our abdomen can be a tumor, or an enlarged liver or spleen, or even a baby. But usually it is fat. When we put on weight, we deposit fat on the outside, between the abdominal wall and the skin. And we deposit it on the inside. This causes pressure and tension. And this can lead to hernias and hernia recurrence after surgery.

Therefore, losing weight is an important aspect of successfully treating hernias.

The main parameter we look at is BMI, or body mass index. It helps us to gauge a person's weight relative to their height. It is certainly not a perfect index, and there are reasons that the same BMI in two different people may not mean the same thing. But it is a helpful thumbnail sketch to measure where we are. According to the doctor books, the general breakdown of BMI is as follows:

• Underweight = <18.5
• Normal weight = 18.5 - 24.9
• Overweight = 25 - 29.9
• Obese = >30

In a perfect world, it would great if every hernia patient had a normal BMI. But, realistically, when considering hernia surgery, we don't even blink until the BMI is greater than 32. Every surgeon is different, and every patient is different. We will talk about your individual case in the office, of course. But my usual approach is to balance the benefit of optimizing someone before surgery with the need to proceed with surgery due to the severity of symptoms. Your best chance to have only one (more) hernia operation is to give it the best possible effort this time. The higher a patient's BMI, the more important it is to attempt to lose weight before surgery. Balanced against that importance is the need to proceed under less-than-optimal conditions because a person's symptoms are simply too severe or dangerous. Again, this is a very individualized decision. But we will work with you to develop an individualized treatment plan.

– Dr. Paul Gray