Preparing for Incisional Hernia Surgery: Smoking, Weight, Diabetes, Nutrition and Prehabilitation

Incisional hernia repair takes place in an area of the abdominal wall that has already failed to heal once. Guidelines therefore treat pre-operative optimisation as a topic in its own right. Prehabilitation is a structured effort to improve physical, metabolic and nutritional status before surgery.

Quick answer

In elective incisional hernia surgery, stopping smoking, controlling blood glucose, managing weight, eating adequate protein and doing regular light exercise are defined preparatory steps that aim to reduce wound problems and ease recovery. This may mean postponing surgery for several weeks — often a deliberate choice.

Smoking

Smoking impairs tissue perfusion and wound healing and is associated with wound infection and respiratory complications. Stopping at least four weeks before elective surgery is widely advised, and longer is better. Structured support programmes improve success.

Weight and body mass index

A high body mass index increases intra-abdominal pressure and is a risk marker for wound problems and recurrence. In elective cases a realistic, graded weight target supported by dietary advice may be set. Very rapid, unbalanced weight loss is avoided because it reduces muscle mass.

Diabetes and blood glucose

Uncontrolled blood glucose delays healing and increases infection risk. Measuring HbA1c and optimising treatment with internal medicine or endocrinology support is common practice. Targets are individualised rather than applied as a single threshold.

Nutrition and exercise

• Adequate daily protein intake
• Checking iron, B12, vitamin D and albumin when indicated
• Fibre and fluid intake to prevent constipation
• Reducing or stopping alcohol before surgery
• Regular walking, light endurance work and breathing exercises

Other preparation topics and evidence limits

Treating chronic cough, managing constipation, reviewing anticoagulants, corticosteroids and immunosuppressants and assessing skin integrity all belong to preparation. Evidence strength differs between components: it is more consistent for smoking cessation and glycaemic control, while long-term hernia-specific data on multimodal prehabilitation programmes are still developing. No rates or guarantees are given here.

An example timeline

• 6–8 weeks before: stop smoking, start nutrition and exercise plan, optimise diabetes
• 4 weeks before: review weight target, establish breathing exercises
• 2 weeks before: medication adjustments, anaesthetic assessment, remaining tests
• Operation week: constipation control, skin care, fasting instructions, transport and carer plan

When to seek urgent care

Sudden severe pain at the hernia site, a hard bulge that cannot be pushed back, nausea, vomiting, fever, skin colour change or inability to pass gas or stool requires immediate emergency assessment.

Conclusion

The result of incisional hernia surgery does not begin on the operating table. Smoking, weight, blood glucose, nutrition and fitness can all be improved in the preceding weeks, and in elective cases that time should be used deliberately.