Obesity is a known risk factor for abdominal wall hernia recurrence and complications following repair. A recent study investigated the use of glucagon-like peptide 1 (GLP-1) receptor agonists to facilitate weight loss in obese patients prior to elective hernia repair. The findings suggest that GLP-1 agonists can significantly reduce the time to surgery without increasing postoperative complications.
Study Design and Methods
The retrospective, single-center study reviewed data from 24 obese patients who were prescribed GLP-1 agonists for weight loss before elective hernia repair, and compared them to 22 patients who achieved similar weight loss through lifestyle modifications alone. The primary outcome was the time from GLP-1 agonist initiation (or initial surgery clinic visit for the control group) to surgery. Secondary outcomes included 30-day morbidity, mortality, reoperation rates, and hernia recurrence. Patients with a BMI > 33 kg/m² with ventral, incisional, flank, umbilical, parastomal, inguinal, or hiatal hernia were included.
Key Findings
The study revealed that the mean time from GLP-1 agonist initiation to surgery was significantly shorter in the GLP-1 group compared to the control group (6.3 ± 4.0 months vs 14.7 ± 17.6 months, p = 0.03). Preoperative mean %TWL (GLP-1: 14.9 ± 7.5 vs control: 12.4 ± 6.9, p = 0.39) and mean BMI reduction (GLP-1: 6.0 ± 3.8 kg/m2 vs control: 4.9 ± 2.3 kg/m2, p = 0.43) were not significantly different between groups. The control group had a higher 30-day morbidity rate (27.3% vs 8.3%), though this difference was not statistically significant (p = 0.13).
Implications for Clinical Practice
These results suggest that GLP-1 agonists can be a valuable tool in the prehabilitation of obese patients undergoing hernia repair. The ability of these medications to accelerate preoperative weight loss could potentially increase patient retention in hernia programs and improve access to safe and durable surgical outcomes. According to the study, GLP-1 patients achieved similar preoperative weight loss in terms of %TWL and BMI reduction, with a time to surgery that was several months shorter on average.
Considerations and Future Directions
Despite the promising findings, the study authors note several limitations, including its retrospective design, small sample size, and limited follow-up time. They also acknowledge that access to GLP-1 agonists can be restricted by insurance coverage and cost. Further research is needed to evaluate the cost-effectiveness of GLP-1 agonists in this setting and to identify factors that may predict individual patient responses to treatment. The development of guidelines for GLP-1 agonist use in hernia prehabilitation specifically would be beneficial as well.
Expert Commentary
"The results of this study highlight the potential of GLP-1 agonists to transform the prehabilitation of obese hernia patients," the authors stated. "Compared to the control group, GLP-1 patients achieved similar preoperative weight loss in terms of %TWL and BMI reduction, with a time to surgery that was several months shorter on average."
Conclusion
GLP-1 agonists show promise in accelerating preoperative weight loss for obese hernia patients without negatively impacting postoperative outcomes. Further studies are warranted to evaluate the efficacy and cost-effectiveness of GLP-1 agonists in the perioperative weight management of surgical patients.
