Prehabilitation in Obese Patients with Ventral Hernia: A Narrative Review and Proposal of a Clinical Algorithm

BACKGROUND: Overweight and obesity are major health problems of the 21st century. As a significant risk factor for numerous noncommunicable diseases, obesity is also strongly associated with the development of abdominal hernias, which significantly impair patients' quality of life. The review focuses on the pathophysiological mechanisms linking obesity to hernias and the impact of key prehabilitation components. Available research indicates a complex interrelationship between obesity and the development of ventral hernias, driven by pathophysiological mechanisms such as increased intra-abdominal pressure and chronic inflammation, which weakens the collagen matrix of the abdominal wall. Furthermore, both smoking and alcohol consumption significantly increase the risk of abdominal obesity and surgical complications; in turn, physical activity is crucial for reducing visceral fat. Psychological support may reduce pre-operative stress and contribute to improved outcomes. Nutritional intervention and weight loss are other essential components of preoperative management for ventral hernia repair. This review aims to highlight the role of prehabilitation in ventral hernia surgery in obese patients and to propose a structured, evidence-based algorithm (DEPP) for this high-risk population. The algorithm includes: Dietary intervention (D), Elimination of smoking and alcohol consumption (E), Physical activity (P), and Psychological support (P). The algorithm was developed to systematize the clinical approach and determine the steps to be taken in the treatment of patients with obesity and abdominal hernia. METHODOLOGY: A literature search was conducted across PubMed, Scopus, and Google Scholar databases for articles published between 2002 and 2026. We included randomized controlled trials, prospective/retrospective cohort studies, systematic reviews, and meta-analyses. CONCLUSIONS: Prehabilitation is a multifaceted strategy for optimizing the health of patients with obesity prior to abdominal hernia repair. The proposed prehabilitation algorithm, known as DEPP, is a preliminary approach for managing this group of patients.