• Mike K Liang, Karla Bernardi, Julie L Holihan, Deepa V Cherla, Richard Escamilla, Debbie F Lew, David H Berger, Tien C Ko, and Lillian S Kao.
• Surgery Department, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX.
• Ann. Surg. 2018 Oct 1; 268 (4): 674-680.

ObjectiveThe 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.BackgroundObesity and poor fitness are associated with complications following VHR. These issues are prevalent in low socioeconomic status patients.MethodsThis 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.ResultsAmong 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).ConclusionsIt 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 RegistrationThis trial was registered with clinicaltrials.gov (NCT02365194).

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