How Obesity Increases the Risk of Complications in Hernia Surgery

Obesity is generally defined as condition in which there is excess body deposition of body fat which in turn results in various adverse effects on the body.

Obesity has become a major concerning issue in the global scale which been observed as a major threat which has increased dramatically in last two decades.

Obesity has aggravated the risk of co morbidities like cardiovascular and cerebrovascular disease, type 2 Diabetes Mellitus, Hypertension and metabolic syndromes.

One of the conditions being Hernia where in there is protrusion of viscera or part of the viscera through the wall of the cavity that contains it. Obesity has direct impact on development of Hernias especially ventral hernias and also has surgical impact on recovery and complications post hernia surgery.

Obesity is categorized based on assessment tool called Body Mass Index (BMI), which is obtained by dividing body weight in Kgs divided by the square of height in meters. Any value >30 is labeled as obesity.

The various problems or complication associated with obesity (high BMI) and hernia being as follows:

1.Impact of excess fat in visceral and subcutaneous compartment: Excess fat in the visceral compartment can increase the intra abdominal pressure, thus is a risk factor for herniation and metabolic disease. Whereas excess subcutaneous fat is a direct risk factor for wound complications like delayed wound healing and wound infections. The risk of Seroma, Hematoma, Mesh infection rates are also high. These complications are significantly higher in open procedures compared to laparoscopic surgeries.
2.Recurrence risk: Obesity increases the strain on abdominal wall (fascia and muscles) rendering it weak and is responsible for the development of ventral hernias.
3.Longer Surgery, less relief of pain, delayed healing process and longer hospital stay/Cost
4.Increased risk of life threatening complications like Deep Vein thrombosis and Pulmonary embolism
5.Associated co-morbidities and risk factors like Diabetes, heart diseases and lung disorders can significantly impact the intra/post operative recovery period resulting in complications.
6.Smoking can have direct effect with delayed wound healing and risk of complications.

Measures/ strategies to minimize complications in hernia patients with obesity:

1.Individuals with non complicated hernias, a focus should be oriented towards managing the obesity with various life style therapy/weight loss programs, proper nutrition. Pre optimization of comorbities before any planned surgery.
2.Minimally invasive approach (Laparoscopy) is the preferred procedure of choice in obese individuals.
3.Multidisciplinary approach with surgeons, Physicians, Endocrinologist, Anesthesiologist, Physiotherapy, nursing care working as a team in managing the patient.
4.Advise pre and post operative fitness protocols with good breathing exercise, walking under physiotherapy guidance
5.Care of skin to minimize wound infection and promote wound healing.

Dr. Avinash K, Consultant Minimal Access and General Surgeon, KMC Hospital, Ambedkar Circle, Mangalore