The impact of a preoperative rehabilitation program on weight loss, surgical decision-making, and postoperative weight maintenance in a hernia center.

INTRODUCTION: Preoperative rehabilitation programs may improve surgical outcomes. As postoperative weight gain is a risk factor for hernia recurrence, we aimed to evaluate the impact of a weight loss program on preoperative body mass index (BMI) reduction and surgical decision-making. METHODS: Patients with ventral hernia enrolled in the weight loss program between 2021 and 2023 were retrospectively assessed. Patients with early follow-up loss were excluded. Demographic and clinical data were collected. Weight was assessed at initial visit, preoperatively, postoperatively, and at last follow-up. Our protocol focuses on weight loss, smoking cessation, diabetes optimization, and services such as Botulinum toxin injection and physical therapy for abdominal strength. Statistical analyses were performed using R. RESULTS: Of 578 patients, 165 (28.5%) entered the program; 109 met inclusion criteria (53% female; mean age 59 ± 11 years). Median prehabilitation duration was 104 days with three clinic visits. Median weight and BMI reductions were − 5 kg and − 1.9 kg/m², respectively. Recurrent hernia was associated with greater preoperative weight loss, while residence in socioeconomically distressed communities was associated with weight gain. 59 patients (54.1%) underwent surgery and had lower final BMI and greater weight loss (p < 0.001). Surgical completion was less likely among non-White patients. Most underwent robotic repair (85%), and no major complications or recurrences occurred. Pre- and postoperative weight changes were not correlated. CONCLUSION: Our prehabilitation demonstrated meaningful BMI reduction and low postoperative morbidity in patients who engaged in the program. While prehabilitation might reduce recurrence risk, larger randomized and group-controlled studies are needed to confirm long-term benefits.