Patients With Severe Obesity Are Made Eligible for Complex Abdominal Wall Repair After Preoptimization With GLP-1 Agonists: Results of a Bicentric Pilot Study.

BACKGROUND: Incisional hernia repairs (IHRs) are not recommended in patients with severe obesity (BMI ≥ 35 kg/m). Weight loss is challenging, but new medications, such as glucagon-like peptide-1 receptor agonists (GLP-1 agonists), have recently attracted increased attention for their potential weight loss advantages. The aim was to analyze the preliminary results about the safety and weight loss efficiency of the use of GLP-1 agonists in the context of prehabilitation prior to complex IHR. METHODS: All patients planned for IHR with a BMI ≥ 35 kg/m and treated with preoperative GLP-1 agonists were included in the experimental group and compared with a comparable historical surgical cohort treated with a conventional tailored nutritional preoperative management. Weight loss in the experimental group and perioperative and postoperative outcomes were compared between the two groups. The success rate of GLP1 agonists was defined as a weight loss that enables the patient to fall within the recommended limits of a BMI ≤ 35 kg/m before an IHR. RESULTS: Fifty-two patients in the control group were compared to 24 with GLP-1 agonists. The distribution of GLP-1 agonists was as follows: semaglutide (n = 12; 50%), dulaglutide (n = 7; 29.2%), and liraglutide (n = 5; 20.8%). The mean initial BMI was 40.1 ± 3.6 kg/m kg/m. The average percentage of weight loss was 11.3 ± 7.4% with GLP-1 agonists (maximum weight loss was observed with semaglutide 2.4 mg/wk). The success rate of GLP1 agonists (defined as BMI ≤ 35 kg/m before IHR) was reached for 15/24 patients (62.5%). Postoperative total complication rate was lower in the group with GLP-1 agonists (59.6% in the control group vs. 45.8% in GLP-1 and p = 0.2). CONCLUSION: This study demonstrated the efficacy of GLP-1 agonists in the optimization of patients with obesity, allowing two thirds of the patients to benefit from IHR, with a tendency for lower morbidity. TRIAL REGISTRATION: CPP Mediterranee, n° 21.00430.000004.