Obesity as a Predictor of Recurrence After Umbilical Hernia Repair: Evidence from a Rural Tertiary Care Hospital

Umbilical hernia is a frequent abdominal wall defect encountered in adults, often requiring surgical intervention. While elective repair is generally straightforward, recurrence after repair remains challenging, with reported rates ranging from 2% to 20% depending on surgical technique, mesh use, and patient-related risk factors.[1,2] obesity has consistently been identified as one of the most important contributors to recurrence.[3]

Obesity increases intra-abdominal pressure, impairs wound healing, and predisposes to surgical site complications, all of which may influence long-term surgical outcomes.[4] Several studies have demonstrated that patients with body mass index (BMI) ≥30 kg/m² have significantly higher recurrence rates than normal-weight individuals.[5,6] Moreover, obesity is frequently associated with comorbidities such as diabetes and hypertension, which may further complicate recovery.

In India, the prevalence of obesity is increasing, particularly in urban and peri-urban areas, while rural regions continue to face dual burdens of undernutrition and obesity.[7] Despite this, literature on the association between obesity and hernia recurrence in rural Indian populations is scarce. Understanding this relationship in low-resource settings is vital, as recurrence increases patient morbidity, healthcare costs, and hospital workload.

Therefore, it is interesting to examine the association between obesity and recurrence rates after umbilical hernia repair in a rural tertiary care hospital in western India.

Study Design and Setting

This was a hospital-based, cross-sectional observational study in the Department of General Surgery at Vedantaa Institute of Medical Sciences, Dahanu, Palghar, Maharashtra. The study was conducted over three months from January 1 to March 31, 2025.

Study Population and Sample Size

A total of 40 adult patients who underwent surgical repair for umbilical hernia during the study period were included. The sample size was determined by the available cases within the timeframe.

Inclusion and Exclusion Criteria

Inclusion criteria were adult patients (≥18 years) undergoing elective or emergency repair for umbilical hernia. Exclusion criteria included patients with recurrent hernias at presentation, those with incisional hernias, patients with significant comorbidities contraindicating surgery, and those who did not provide informed consent.

Data Collection

Sociodemographic data, BMI, comorbidities, surgical details (open vs mesh repair), and postoperative outcomes were recorded. BMI was calculated as weight in kilograms divided by height in meters squared and categorized according to WHO criteria: non-obese (<30 kg/m²) and obese (≥30 kg/m²). Recurrence was defined as a clinically detectable or ultrasonographically confirmed hernia during follow-up within the study period at the repair site.

Ethical Considerations

Approval for the study was obtained from the Institutional Ethics Committee. Written informed consent was taken from all participants. Confidentiality and anonymity were maintained throughout.

Statistical Analysis

Data were entered into a secure database and analyzed using SPSS software. Continuous variables were summarized as mean ± SD, while categorical variables were presented as frequencies and percentages. The chi-square test was used to compare recurrence rates between obese and non-obese patients. Logistic regression was performed to identify independent predictors of recurrence. A p-value <0.05 was considered statistically significant.

A total of 40 patients underwent umbilical hernia repair during the study period. The mean age of the cohort was 44.8 ± 11.6 years, with 26 males (65%) and 14 females (35%). Sixteen patients (40%) were classified as obese (BMI ≥30 kg/m²), while 24 (60%) were non-obese. The overall sociodemographic and clinical distribution is summarized in Table 1.

Table 1. Sociodemographic and clinical profile of study participants (n = 40)

Surgical details revealed that mesh repair was performed in 75% of patients, most undergoing open procedures. Emergency repair was required in 20% of cases (Table 2).

Table 2. Surgical details of patients undergoing umbilical hernia repair

When recurrence rates were compared according to BMI, obese patients had a significantly higher recurrence rate (37.5%) compared to non-obese patients (12.5%), with the difference reaching statistical significance (p = 0.04) as shown in Table 3.

Table 3. Recurrence rates according to BMI

Further analysis of recurrence concerning perioperative factors demonstrated that while obesity was significantly associated with recurrence, comorbidities, type of repair, and emergency status were not statistically significant predictors (Table 4).

Table 4. Factors associated with recurrence after umbilical hernia repair

On logistic regression, obesity emerged as an independent predictor of recurrence after umbilical hernia repair (OR 4.20, 95% CI 1.01–17.46, p = 0.048). Mesh repair showed a protective trend, though not statistically significant. Full multivariate results are presented in Table 5.

Table 5. Logistic regression analysis for predictors of recurrence

This study demonstrated that obesity was significantly associated with higher recurrence rates after umbilical hernia repair in a rural Indian cohort. Recurrence occurred in 37.5% of obese patients compared to 12.5% of non-obese patients, and logistic regression confirmed obesity as an independent predictor (OR 4.20, p=0.048). These findings are consistent with prior literature showing that increased body mass index contributes to raised intra-abdominal pressure, impaired wound healing, and greater tension at the repair site, predisposing to recurrence.[8,9] Similar associations have been reported in Western populations, where obesity is a well-established risk factor for hernia recurrence and postoperative morbidity.[10,11]

Our results also highlight that although mesh repair was protective, it did not eliminate recurrence in obese patients. Previous large-scale studies have confirmed that mesh reinforcement reduces recurrence rates compared with suture repair; however, obesity still undermines outcomes even with mesh use.[12,13] This underscores the need for comprehensive perioperative management in obese patients, including weight reduction strategies, optimization of comorbidities, and careful surgical planning. In LMICs, where laparoscopic options are less accessible, reliance on open mesh repair may be insufficient to counter the risks posed by obesity.[14]

From a public health perspective, the rising prevalence of obesity in India poses an increasing challenge for hernia management, especially in rural areas with limited surgical resources.[15] Recurrence adds to patient morbidity and increases healthcare costs and surgical workload. Therefore, integrating preoperative counseling on weight management, promoting lifestyle modification, and ensuring timely elective repair before hernias enlarge could mitigate recurrence rates. Although this study was limited by its small sample size and short follow-up, it provides valuable context-specific evidence supporting obesity as a modifiable risk factor for recurrence after umbilical hernia repair in low-resource settings.

This study found that obesity is a significant and independent predictor of recurrence after umbilical hernia repair in a rural Indian population. Recurrence rates were notably higher in obese patients despite the use of mesh repair, underscoring the physiological impact of increased intra-abdominal pressure and impaired healing in this group. These findings highlight the importance of incorporating weight management and optimization of comorbidities into preoperative planning, alongside timely elective repair, to reduce recurrence risk. Strengthening perioperative counseling and preventive strategies is essential, particularly in low-resource settings where recurrence burdens patients and healthcare systems.

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