I am over-weighted, they do not want to make the hernia operation…

They said that I should first loose and that they could make the operation then…

I can not have a hernia operation due to that I can not loose weight…

Do I not have a chance of being relieved from hernia if I have too much weight?

We often hear statements such as above. Especially umbilical and incisional hernias are seen more frequent at patients with weight. Over-weight hardens any surgical process. Beside this, umbilical hernias re-incur more frequent at weighted patients. But if a tension-free repair with meshes is performed, when the correct mesh is used, placed at the right location and fixed with the adequate material, the re-incur is theoretically zero even at obese persons.

The table above shows the abdomen intern pressure changes during daily activities. Even at jumping, which increases the abdomen intern pressure the most, the pressure only rises up to 250 mmHG at obese persons. The pressures, which contemporary used meshes can resist, are much higher than this.

At another work. Again the abdomen intern pressure measurements during daily activities and the pressures, which utilized meshes can resist, are shown. Even the thinnest and weakest meshes can resist values much above the abdomen intern possible maximum pressures.

Graphic 1 shows the abdomen intern pressures and the pressures, which the meshes can resist in mmHG.

If the correct mesh is applied with the correct technique, the weight of the patient has no importance: the abdominal wall hernias of even extreme weighted patients can be restored safe. Because the resistance of the used meshes are 3-4 times higher than the possible abdomen intern pressure.

If the hernia region is closed with sewing instead of a tension-free restoration with meshes, if the mesh to be used is selected false, if the mesh should not be placed behind the muscle and at a wrong plan and if this not be fixed at the place with the correct material, so due to that the performed work will not be strong enough , the special conditions of the patient will be important. One and the most important of these special conditions may be the over-weight of the patient. Therefore, formerly patients were told to loose weight and get operated afterwards.

The risk of the over-weight is that too much load is applied on the restored location. If a repair by sewing should be applied to the patient, there is a risk to be torn in case of an increase of the abdomen intern pressure. And in case of a placement of the mesh on the muscle, ON-LAY fixation of it, the increasing abdomen intern pressure may loosen and reject this from the cover place. Thus, the operation technique is much more important than the weight of the patient.

Back to the answer of the first question; of course, a reduction of the weight will ease the operation technically. But the response, “first loose weight, and then get operated” of some hospitals might possibly correspond to the practice. Sometimes, it may be a way for the surgeon to avoid a difficult case.

As a result, every patient at any weight can have a successful operation at a tension-free repair with meshes. For this, it is necessary to know the different meshes and to chose the most adequate mesh for the patient. It is very important that the selected mesh is fixed to the correct location  with the correct material.