Archives: January 2026

High BMI: A Stepping Stone, Not a Stop Sign, for Hernia Repair

For patients living with obesity, any conversation about surgery comes with added considerations. If your Body Mass Index (BMI) falls into the morbidly obese range (40+), elective operations may not be recommended.

Most surgeons are committed to a patient-first, low-risk approach, so when it comes to a common issue like a hernia, it’s often safer to encourage weight reduction before surgery. When you do undergo surgery, the risks are minimized, and the results are longer-lasting.

Why does your BMI make a difference?

A host of health challenges are associated with a BMI of 40 or higher, which is classified as morbid obesity. Many patients experience coexisting conditions such as type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, or acid reflux.

Higher BMI also increases the risk of complications during anesthesia and surgery, including cardiovascular and pulmonary issues, infections, delayed wound healing, and a greater chance of hernia recurrence due to increased pressure on the abdominal wall. From a surgical perspective, our primary concern is safety.

How Do Hernias Form?

Hernias happen when a weak spot or small hole develops in the fascia, the strong layer of tissue that holds your abdominal muscles and organs in place. Unlike skin or other tissues, the fascia can’t heal itself once it’s stretched or torn. Hernias don’t get better on their own.

Most abdominal hernias begin small and gradually enlarge. Many people notice them only when they cause discomfort, produce a visible bulge, or interfere with daily activities. That’s usually when surgeons recommend repair. Some hernias don’t cause symptoms right away, and in those cases, doctors may choose to watch them closely. One exception is a femoral hernia. More common in women, these might appear as a lump in the upper thigh and carry a higher risk of complications.

Only approximately 1-2% of groin hernias become serious. Incarceration occurs when abdominal tissue or intestine becomes trapped in a hernia sac and cannot be reduced. Strangulation occurs when the blood supply to the trapped tissue is cut off, causing rapid tissue death. While rare, both situations are serious and need immediate medical attention.

In an emergent situation, surgery becomes more dangerous for someone with a high BMI. The combination of excess weight and urgent conditions complicates anesthesia, wound healing, and recovery. In an elective repair, surgeons can plan the procedure carefully, optimize the patient’s health, and take steps to reduce complications.

How Are Hernias Managed in Patients with a High BMI?

For patients with excess body weight, surgeons will likely recommend addressing hernias in stages rather than proceeding with repair. Small hernias that cause minor symptoms are usually monitored. In some cases, minor repairs can be performed safely. However, larger or more complex hernias are usually deferred until weight loss reduces surgical risk.

The goal is to minimize risk while maximizing long-term results. Reducing pressure from excess weight on the abdominal wall reduces the risk of recurrence and improves postoperative healing. Even though delaying surgery can feel frustrating, it’s the best way to protect a patient’s health and get the most durable results.

Are Hernias Repaired During Bariatric Surgery?

Sometimes hernias are discovered before weight loss surgery, but often we discover them during a bariatric procedure.

Whether it’s repaired right away depends on its size, location, and contents. Small hernias that can be closed with simple sutures may be repaired during the same operation. Larger hernias, or those containing a significant amount of intestinal tissue, are often postponed for the reasons stated above. Waiting 6-9 months allows the patient to recover from weight loss surgery, lose a significant amount of weight, and potentially control comorbidities. This reduces surgical risk when it is time to repair the hernia.

Hiatal hernias are an exception. These occur when the opening in the diaphragm that allows the esophagus to pass through widens, letting the stomach push up into the chest. Hiatal hernias can worsen acid reflux before and after bariatric surgery. Because of this, surgeons usually repair hiatal hernias during bariatric procedures, especially if the patient has reflux already. Even with repair, some risk of acid reflux remains, and patients are informed about this during consultation.

If you have a hernia and are considering bariatric surgery, the team at SAMPA is here to help. A coordinated team effort and careful timing make all the difference in your recovery and long-term well-being.

SAMPA is a regional leader in laparoscopic and robotic general and weight loss surgery. Our practice comprises leaders in our field who have performed some of the region’s and the nation’s first specialized operations. We are the largest surgical group in the region with 5 highly skilled and experienced surgeons.

Your Brain on Stress After Bariatric Surgery

Do cravings get louder when life gets overwhelming? It isn’t random.

Even after surgery, your stress circuits remain intact. And they’re still very good at doing their job.

Stress Response

Perceived threats activate a region of the brain called the hypothalamus. A cascade of signaling courses through the hypothalamic-pituitary-adrenal (HPA) axis that results in cortisol release from the adrenal glands. Cortisol mobilizes glucose into the bloodstream so your body has quick fuel. In the face of true danger, that extra energy helps you respond quickly: fight or flight.

Your limbic system, a complex system of brain structures that controls basic emotions and instincts, is also triggered. Your brain becomes more alert to potential problems. The part responsible for planning and impulse control (prefrontal cortex), on the other hand, becomes less dominant. In other words, stress negatively affects your decision-making.

Acute stress comes on, cortisol rises, glucose increases, and the body returns to baseline once the threat passes. In short bursts, this system works beautifully. Chronic stress is different.

When stress signals remain activated for weeks or months, the brain continues to scan for threats. Your brain doesn’t register the difference between modern stress (like traffic, bills, and poor social interactions) and a true threat (like being chased by a wild animal); it reacts the same, so cortisol levels stay elevated, impulse takes precedence over sound decision-making, and cravings become more frequent.

Cost of Chronic Stress

Chronic stress can blunt some of the metabolic improvements that bariatric surgery was designed to support.

Persistently elevated cortisol promotes visceral fat deposition, which is the type that’s stored around abdominal organs. This form of fat is hormonally active and more closely associated with insulin resistance and cardiovascular risk. To make matters worse, prolonged exposure to high cortisol levels also reduces insulin sensitivity. When insulin responsiveness declines, blood glucose regulation becomes less efficient.

In a chronic stress state, the body may break down muscle tissue to provide amino acids for energy production. Loss of lean muscle mass lowers resting metabolic rate, which can make weight maintenance more challenging.

Stress can also interfere with deep, restorative sleep. That disruption compounds the issue. When sleep quality declines, ghrelin (the hormone that stimulates appetite) rises, while leptin (the hormone that signals fullness) falls. Even with a smaller stomach, mismatched signaling can intensify and confuse your hunger cues.

Weight loss plateaus and regain can feel like surgery failed, but if you find yourself chronically feeling maxxed out, it might just be your body responding to sustained stress signals.

Surgery Doesn’t Fix Stress

The limbic system continues to respond to stress after surgery. The prefrontal cortex still struggles to override impulsive eating when life feels chaotic.

If you’re experiencing any of these, pay attention:

• Increased cravings
• A plateau during major life changes
• Grazing behaviors
• Late-night eating
• Fatigue and slower recovery from workouts

Your ability to attune to your body allows for intervention before they become entrenched habits.

Calming the Nervous System Is a Medical Strategy

Managing stress is medically necessary – for protecting your weight loss efforts as well as your overall health.

Sleep is foundational. Consistent bedtimes and turning off digital devices improve cortisol rhythms and appetite regulation.

Resistance training and cardioprotective exercise preserve lean muscle mass, improve insulin sensitivity, and combat the effects of chronically elevated cortisol. Exercise even releases endorphins, which make you feel better.

Adequate protein intake supports muscle maintenance. Structured meal timing reduces blood sugar fluctuations that can amplify cravings.

Breathing exercises are simple and accessible ways to reduce stress in the moment. Slowing down diaphragmatic breathing has measurable beneficial effects on heart rate variability.

Behavioral therapy is essential. Chronic stress, anxiety, depression, or unresolved trauma can sustain HPA axis activation. Working with a licensed mental health professional is a medically appropriate step in protecting long-term surgical outcomes.

At SAMPA, bariatric care is a team effort. Surgeons, dietitians, medical providers, and behavioral health professionals have your back and want you to succeed. If you notice stress affecting your eating patterns, energy levels, or weight trajectory, reach out to us.

Stress is part of life. With the right tools and the right team, it does not have to control your progress.