Management of abdominal wall hernias in bariatric patients: a narrative review

Background and Objective: Abdominal wall hernias (AWH), characterized by defects or weaknesses in the abdominal wall, have increasingly impacted the well-being of patients with obesity and bariatric patients. This review article investigates the relationship between obesity, bariatric surgery (BS), and the management of AWH. Our objective is to analyze the pathogenesis, prevention, and contemporary techniques recently published for the treatment of AWH. Additionally, we propose an algorithm that serves as a systematic approach for the management of hernias in patients with obesity, consolidating the latest findings and experiences from the past 5 years in this field. Methods: We conducted a literature search across PubMed, Embase, and Scopus, to identify studies that focused on AWH management in the context of obesity and BS. Manuscripts were categorized based on hernia type, the pathogenesis associated with obesity, approaches for management, procedural timing, mesh selection, and reported outcomes—all specifically tailored to bariatric patients. Key Content and Findings: This narrative review comprehensively addresses the unique factors that render bariatric and patients with obesity susceptible to AWH. We explore current strategies for hernia prevention and a diverse array of approaches employed to treat these AWH in the context of BS. Our findings encompass a detailed analysis of surgical techniques, ranging from conventional methods to innovative minimally invasive approaches. We highlight the significance of a multidisciplinary approach to assure the best outcome. Conclusions: The management of AWH in BS patients represents a variety of challenging surgical procedures that require a multidisciplinary approach. The findings presented provide insights into tailored management strategies, their implications for clinical practice, and directions for future research in the field of AWH in bariatric patients.