Tirzepatide-Based Prehabilitation Before Elective Ventral and Incisional Hernia Repair in Patients With Obesity

This study investigated whether a structured weight-loss program using tirzepatide could improve the condition of patients with obesity before undergoing elective ventral or incisional hernia repair. Obesity is a well-recognized risk factor for hernia formation, postoperative complications, and hernia recurrence, yet many patients struggle to achieve sufficient weight loss through diet and exercise alone. Tirzepatide, a medication that targets both GIP and GLP-1 receptors, has recently shown remarkable effectiveness in promoting weight reduction, but its role as a preoperative optimization strategy in abdominal wall surgery had not previously been evaluated in a prospective multicenter setting.

Researchers conducted a retrospective study across four specialized abdominal wall surgery centers. Adults with obesity (body mass index ≥30 kg/m²) and medium-to-large ventral or incisional hernias scheduled for elective repair were enrolled in a 16-week multidisciplinary prehabilitation program. Participants received weekly tirzepatide injections with gradual dose escalation, together with nutritional counseling and physiotherapy. The goal was to achieve at least 10% total body weight loss or reduce body mass index to 33 kg/m² or lower before surgery. Outcomes were compared with a control cohort of obese patients who had undergone similar hernia repairs without pharmacological prehabilitation.

A total of 109 patients entered the program, and 91 (83.5%) successfully completed the full 16-week course and proceeded to surgery. The average weight loss among completers was 13.8%, with body mass index decreasing from 34.5 kg/m² at enrollment to 27.5 kg/m² at the time of surgery. Importantly, every patient who completed the program reached the predefined preoperative weight target, demonstrating the feasibility and effectiveness of this approach.

The study also examined postoperative outcomes. Patients who underwent tirzepatide-based prehabilitation experienced lower rates of wound-related complications, including seroma formation, surgical site infection, hematoma, mesh infection, and chronic postoperative pain, compared with the control group. Overall surgical site occurrences were reduced from 22.1% in controls to 8.8% in the tirzepatide group. Multivariable analysis confirmed that participation in the tirzepatide program was independently associated with a significantly lower risk of postoperative surgical-site complications.

Treatment was generally well tolerated. Only four patients discontinued therapy because of mild gastrointestinal side effects such as diarrhea or reflux. The most common reason for discontinuation was the financial cost of treatment, highlighting a potential barrier to wider implementation.

Although follow-up remains relatively short and the comparison group was not randomized, these findings suggest that tirzepatide-based prehabilitation may represent an effective strategy for preparing patients with obesity for abdominal wall hernia surgery. By enabling substantial preoperative weight loss and potentially reducing postoperative complications, tirzepatide may help improve surgical outcomes and expand access to elective hernia repair for patients who might otherwise be considered high-risk surgical candidates. Larger studies with longer follow-up are needed to confirm these promising preliminary results.

Inclusion criteria

• Age ≥ 18 years
• Body mass index (BMI) ≥ 30 kg/m²
• Elective primary ventral or incisional midline hernia
• European Hernia Society (EHS) width W2 (4-10 cm) or W3 (> 10 cm)
• Hernia amenable to a standard Rives-Stoppa retromuscular repair
• Able and willing to comply with the prehabilitation program and scheduled follow-up

Exclusion criteria

• Emergency presentation or incarcerated/strangulated hernia
• Contraindication to tirzepatide (personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2; prior pancreatitis; severe gastrointestinal disease; pregnancy or lactation) Ongoing treatment with another anti-obesity medication
• Prior bariatric surgery within the preceding 12 months
• Hernia requiring posterior component separation or transversus abdominis release (TAR)
• Inability to comply with follow-up