Obese patients with a high BMI are not operated on “because the medical manual says so.” There are biological and mechanical reasons that make surgical treatment more urgent—and often safer than letting the problem drag on until it explodes.
The main reason, put simply, is physics. Increased intra-abdominal pressure acts like a massive hydraulic press on every weak point of the abdominal wall. Hernias grow faster, incarcerate more often, and in general have a worse natural course in bodies with a high BMI. The “let’s see how it goes” approach does not go well here. Breathing is also affected because of diaphragmatic pressure.
In addition, the inflammatory and metabolic milieu of obesity impairs wound healing. A surgery that in another patient would close like a zipper can, in an obese patient, turn into ulcers, seromas, and infections. Fixing a hernia while it is still small and manageable greatly reduces this risk.
Waiting also often leads to bad timing. If obstruction or strangulation occurs, emergency operations always have higher complication rates, and in obesity the difference becomes dramatic.
There is something else as well: the laparoscopic approach usually benefits these patients disproportionately. A thick fat layer means difficult open access, large wounds, and more infections. Doing the job from the inside with small ports markedly improves recovery.
None of this means that obesity automatically makes someone “mandatory for surgery.” The older term morbid obesity is outdated; today we use severe obesity. There are now validated charts that indicate when an obese patient (depending on age and BMI) is likely to develop serious complications that threaten health or even life.
What this means is that when there is a clear indication, postponement does not work in the patient’s favor. This is where a more honest discussion begins: when to intervene preventively, when to optimize weight first, and when to use anti-obesity medications beforehand.
By operating on patients with obesity and increased BMI, the following conditions can be reversed or significantly improved:
- Sleep apnea (risk of dying during sleep)
- Improvement or regression of fatty liver disease
- Improvement or even remission of type 2 diabetes
- Improvement or full control of arterial hypertension
- Improvement of joint disease and lumbar spine–related conditions
- Prevention of cardiovascular events (myocardial infarction, stroke)
- Improvement in fertility, among others
