Hernias are frequently seen in patients living with severe obesity. They can cause discomfort, visible abdominal bulging and sometimes significant pain. In higher BMI patients, they also present a surgical challenge.
Many people are simple told they should lose weight before having a hernia repaired. That advice is not given lightly. There are sound medical reasons behind it – but simply telling patients living with obesity to lose weight through diet and exercise so they can have a hernia repaired is not enough. They need a real treatment for the disease of obesity and that is where surgery is so effective.
Understanding why hernias are more common in severe obesity helps explain why treatment planning needs specialist input.
Why Severe Obesity Increases Hernia Risk
A hernia develops when tissue pushes through a weakened area of the abdominal wall. In patients with high BMI, several factors increase the likelihood of this happening.
Constant internal pressure
Excess intra-abdominal fat raises pressure inside the abdomen. Over time, this strains natural weak points such as the umbilicus or previous surgical scars.
Previous abdominal surgery
Patients with obesity are more likely to have had procedures such as gallbladder surgery or caesarean sections. Incisions can weaken the abdominal wall, leading to incisional hernias.
Reduced tissue strength
Obesity affects collagen and tissue quality. The abdominal wall may not hold sutures or mesh as effectively, increasing recurrence risk after repair.
This is why umbilical, ventral and incisional hernias are more common in patients with a high BMI.
Why Hernia Repair Alone Can Be Problematic
Repairing a hernia without addressing severe obesity often leads to:
- Higher recurrence rates
- Increased wound complications
- Greater infection risk
- Technical difficulty due to abdominal wall thickness
In some patients, repairing the hernia first may only provide temporary relief if abdominal pressure remains high.
That is where bariatric surgery can change the long-term outcome.
Can Hernia Repair Be Done During Bariatric Surgery
In selected cases, yes. The decision depends on:
- The size and type of hernia
- Whether it is symptomatic
- Risk of bowel obstruction
- Overall BMI and medical condition
Small hernias can sometimes be repaired at the same time as a bariatric procedure such as Gastric Sleeve, Gastric Bypass or SADI-S. Very often however they are repaired at a later date when there has been significant weight loss and the repair is then likely to be more robust and enduring.
Larger or complex abdominal wall defects may be better treated in stages. In these cases, weight loss surgery is performed first. Once weight has reduced and surgical risk is lower, hernia repair can follow under safer conditions.
There is no standard rule.
The Importance of Specialist Assessment
This is where experience matters.
Mr William Robb is an Upper GI Surgeon and Robotic Bariatric Surgeon with extensive experience in complex abdominal surgery. His background in upper gastrointestinal surgery means he regularly manages conditions involving the stomach, oesophagus and abdominal wall, alongside bariatric procedures.
At Blackrock WeightCare, assessment involves:
- Careful physical examination
- Imaging where needed
- Review of previous surgical history
- Evaluation of metabolic health and BMI
- Discussion of the safest sequencing of procedures
Robotic surgical techniques are used where appropriate, particularly in higher BMI patients. Robotic assistance allows greater precision and improved visualisation inside the abdomen, which can be especially helpful when managing both bariatric surgery and hernia repair in the same setting.
The key decision is not simply whether surgery can be combined. It is whether it should be combined in your specific case.
What Patients Can Expect
If you are being assessed for both severe obesity and a hernia, you can expect:
- A detailed consultation
- Honest discussion about risks and benefits
- Clear explanation of whether a combined or staged approach is safer
- Structured preparation before surgery
- Long-term follow-up after bariatric treatment
If a combined procedure is appropriate, both issues are addressed in one surgical setting. If staging is safer, you will understand why and what the timeline looks like.
Why Treating Obesity Improves Hernia Outcomes
Sustained weight loss reduces abdominal pressure. This improves healing, lowers recurrence risk and makes future abdominal surgery safer.
In many patients, addressing obesity first creates better long-term results for hernia repair.
Managing hernias in the setting of severe obesity requires careful judgment. A specialist assessment at Blackrock WeightCare ensures the decision is based on safety, surgical expertise and long-term outcome.
If you would like to discuss your case, you can click to enquire here or speak directly with our team on 01 255 2479.
Your Health. We Care.
