Tirzepatide-Based Prehabilitation Before Elective Ventral and Incisional Hernia Repair in Patients With Obesity:A Prospective Multicenter Cohort Study With a Comparative Control Cohort

This study evaluated whether a 16-week weight-loss program using tirzepatide before elective ventral and incisional hernia surgery could improve surgical readiness and outcomes in patients with obesity. In this retrospective multicenter study, 109 patients entered the program, and 91 completed treatment and underwent surgery. Participants achieved an average weight loss of 13.8%, and all patients who completed the program reached the target weight required for surgery. Compared with a control group of obese patients who underwent hernia repair without pharmacological prehabilitation, the tirzepatide group experienced fewer postoperative wound-related complications.

Study Overview

• Status: Completed
• Conditions: Prehabilitation; Hernia Abdominal Wall; Obese Adults
• Intervention / Treatment: Drug: Tirzepatide prehabilitation

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 91

Contacts and Locations

Study Locations

• Italy
  • Naples, Italy, 80131
    • Francesco Pizza

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Adults (≥ 18 years) with obesity (BMI ≥ 30 kg/m²) and an elective primary ventral or incisional midline hernia of European Hernia Society width W2-W3, amenable to a standard Rives-Stoppa retromuscular repair, managed at four high-volume abdominal wall surgery units. The prospective prehabilitation cohort comprises consecutive eligible patients who agreed to undergo a structured 16-week tirzepatide-based preoperative weight-optimization program before elective repair. The comparative control cohort comprises patients meeting the same age, BMI, hernia type, EHS width, and surgical-technique criteria who underwent elective repair without pharmacologic prehabilitation at the same centers over the preceding five years, identified from prospectively maintained institutional databases. Patients requiring emergency surgery, posterior component separation/transversus abdominis release, or with contraindications to tirzepatide were not included.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Preoperative Tirzepatide Cohort; Tirzepatide prehabilitation cohort Adults with obesity (BMI ≥ 30 kg/m²) and an elective primary ventral or incisional midline hernia (EHS width W2-W3) amenable to a standard Rives-Stoppa retromuscular repair, prospectively enrolled across four high-volume abdominal wall units. Before surgery, participants undergo a structured 16-week prehabilitation program based on once-weekly subcutaneous tirzepatide, titrated over the period (2.5 mg in month 1, 5 mg in month 2, 7.5 mg in months 3-4), delivered within a multidisciplinary bundle that also includes dietary counseling and physical/respiratory conditioning. The predefined preoperative target is a total weight loss ≥ 10% or a BMI ≤ 33 kg/m². Elective open retromuscular repair is performed once the target is reached and the program is completed.	Drug: Tirzepatide prehabilitation; Once-weekly subcutaneous tirzepatide administered as a structured 16-week preoperative prehabilitation course, with stepwise dose titration: 2.5 mg/week during month 1, 5 mg/week during month 2, and 7.5 mg/week during months 3-4. The drug is delivered within a multidisciplinary prehabilitation bundle (dietary counseling and physical/respiratory conditioning) in patients with obesity (BMI ≥ 30 kg/m²) scheduled for elective ventral or incisional hernia repair. The predefined preoperative goal is a total weight loss ≥ 10% or a BMI ≤ 33 kg/m²; elective open Rives-Stoppa retromuscular repair is performed once the target is reached and the 16-week course is completed. The maximum dose is capped at 7.5 mg/week, and the course is time-limited to the preoperative window rather than continued long term. What makes this distinct from other tirzepatide interventions (worth keeping in the wording, as the field asks): it is preoperative and time-limited (16 weeks), capped at 7.5 mg (lower than the u
Comparative control cohort; Patients with obesity (BMI ≥ 30 kg/m²) who underwent elective ventral or incisional midline hernia repair (EHS width W2-W3) by the same standard Rives-Stoppa retromuscular technique, without any pharmacologic prehabilitation, at the same four centers over the preceding five years. This cohort was identified retrospectively from the prospectively maintained institutional databases and applied the same age, BMI, hernia type, EHS width, and surgical-technique eligibility criteria as the prehabilitation cohort. It serves as the non-pharmacologic comparison group for perioperative and short-term surgical outcomes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of tirzepatide-based prehabilitation	Proportion of enrolled patients who complete the 16-week tirzepatide prehabilitation program, reach the preoperative target (≥ 10% total weight loss or BMI ≤ 33 kg/m²), and proceed to elective ventral or incisional hernia repair.	16 weeks (from initiation of prehabilitation to surgery)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Preoperative weight optimization	Mean preoperative total weight loss (%) and reduction in BMI from enrollment to surgery, and the proportion of patients reaching the predefined target (≥ 10% total weight loss or BMI ≤ 33 kg/m²).	16 weeks (from initiation of prehabilitation to surgery)
Composite surgical site occurrence	Proportion of patients with at least one surgical site occurrence (seroma, surgical site infection, hematoma, or mesh infection) after elective hernia repair.	90 days postoperatively
Postoperative morbidity by Clavien-Dindo classification	Severity of postoperative complications graded according to the Clavien-Dindo classification.	90 days postoperatively

Collaborators and Investigators

• Sponsor: Azienda Sanitaria Locale Napoli 2 Nord

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): June 1, 2026
• Study Completion (Actual): June 1, 2026

Study Registration Dates

• First Submitted: June 5, 2026
• First Submitted That Met QC Criteria: June 5, 2026
• First Posted (Actual): June 10, 2026

Study Record Updates

• Last Update Posted (Actual): June 10, 2026
• Last Update Submitted That Met QC Criteria: June 5, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Weight loss; Multidisciplinary care; Surgical site complications
• Additional Relevant MeSH Terms: Pathological Conditions, Anatomical; Body Weight; Body Weight Changes; Hernia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Weight Loss; Hernia, Abdominal
• Other Study ID Numbers: 2128112026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: De-identified individual participant data underlying the results reported in the primary publication, together with the data dictionary, will be made available to investigators whose proposed use is approved by the study steering committee, for analyses aimed at achieving the aims of the approved proposal. Data will be available after publication with no planned end date; requests should be directed to the corresponding author and will require a signed data-access agreement.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No