Effect of Prehabilitation with GLP-1 Agonists in Obese Patients Undergoing Abdominal Wall Reconstruction or Complex Hernia Repair: A Scoping Review

Background: Obesity is a well-established risk factor for hernia development, recurrence, and adverse perioperative outcomes, posing major challenges in patients undergoing abdominal wall reconstruction (AWR) or complex hernia repair (CHR). Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially approved for type 2 diabetes, have demonstrated substantial weight-loss benefits and are increasingly used for preoperative optimization. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted for studies published up to June 11, 2025, evaluating GLP-1RA use in obese adults undergoing AWR or CHR. Studies were selected using predefined criteria. Data were charted and synthesized thematically to assess preoperative weight loss, time to surgery, perioperative safety, wound complications, and feasibility. Results: Three observational studies including 65 obese patients undergoing AWR or CHR were identified. GLP-1RA use was associated with a shorter time to surgery (6.3–9.1 months) compared with controls (13.5–14.7 months) and moderate preoperative weight loss (11.3–14.9%). Thirty-day morbidity was lower or comparable in GLP-1RA groups. Reported adverse events were infrequent, non-serious, and manageable. Conclusion: Preoperative GLP-1RA therapy appears promising as a prehabilitation strategy; however, current evidence is limited to small, heterogeneous observational studies with significant risk of bias. These findings should be considered hypothesis-generating rather than practice-changing.