Obese with hernia: What's the way out?

Obesity is one of the major health problems in India. It is estimated that prevalence of obesity in India will triple over the period 2010 to 2040, while the population of overweight adults (20-69 years of age) will more than double during this period. Obesity brings with it other disorders called co-morbidities like diabetes, hypertension, cardiovascular diseases, and joint issues, among others.

Hernia recurrence is more likely in obese patients. In fact, obese people are not only at a higher risk of hernia formation but failure of hernia surgery among such patients is high. To lessen this risk, overweight or obese patients are often asked to lose weight before undergoing a hernia surgery. However, that's a difficult proposition and is easier said than done.

Vikas Singhal, Senior Consultant, Medanta Medicity Hospital, Gurugram, says, "Bariatric surgery is a type of surgery which not only helps to reduce a significant amount of weight but patients usually get complete remission of co-morbid problems such as Diabetes and Hypertension, lowering the risk of heart disease, cancers etc, and an improvement in the quality of life."

"Abdominal wall hernia cannot be treated by any drug -- it requires surgery. In a few cases, the hernia can come back even after surgery in the patient. Obese patients are at a high risk of hernia recurrence due to a high pressure exerted on the abdominal wall. The hernia surgery in obese patients also carries an increased risk of wound complications. Patients suffering from obesity may also often be diabetic, and suffer from joint pains limiting their movement. Thus, they get into a vicious cycle that makes it very difficult to lose weight on their own -- with just diet and exercise. Hence, Bariatric surgery becomes an important consideration for these patients to help lose weight, reduce complications and reduce the risk of hernia recurrence after surgery. Except in emergency cases for hernia complications, bariatric surgery becomes a near-necessity in such patients," Singhal added.

Referring to one of the patient cases, Singhal said, "An individual aged 51 years was suffering from both Obesity and Hernia. He had gained significant weight (was 138 kg) -- and turned diabetic and also developed a large incisional hernia after his liver transplant surgery. The patient underwent Laparoscopic Sleeve Gastrectomy following which he lost 28 kg weight; his diabetes, too, was cured. He underwent open incisional hernia surgery and was discharged without any perioperative complications."

"In another case, an individual aged 44, was suffering from a painfully large recurrent incisional hernia below the navel following hysterectomy surgery. Weighing 108 kg with Body Mass Index (BMI) of 48 a CT scan performed on the patient showed a large 5x5 cm hernia containing multiple loops of small intestine. As the patient was quite symptomatic from the hernia, the hernia repair could not be deferred till after weight loss. Post-surgery, the patient was discharged uneventfully and returned after two weeks for removal of sutures and diet advancement, having already lost eight kg weight," Singhal added.

Obesity and hernia are common problems which are often associated with one another and compound the problem for the patient. Ultimately, the decision of what is the best solution for this complex problem will need to be individualized for every patient. Those patients needing to undergo this treatment, will need a thorough evaluation, and would need to be well enrolled in a proper plan of care.