AUTHOR=Ahmed Ahsan , Khalid Faizan , Sadeghi Ali , Rodriguez Valladares Marlon , Flores Marlen , Loja Pauta Valeria , Alas-Pineda Cesar , Mandujano Cosman Camilo 
  
TITLE=Radiologic recurrence after minimally invasive ventral hernia repair in patients with class III obesity: a single-center retrospective cohort study
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.17051
  
DOI=10.3389/jaws.2026.17051
  
ISSN=2813-2092
  
ABSTRACT=BackgroundObesity is a known risk factor for complications and recurrence after ventral hernia repair (VHR). Many surgeons defer elective repair in patients with class III obesity based on body mass index (BMI) thresholds. We evaluated postoperative outcomes and factors associated with recurrence after minimally invasive VHR in this high-risk population.MethodsThis single-center retrospective cohort study included consecutive adult patients with BMI ≥40 kg/m2 who underwent predominantly minimally invasive VHR between January 1, 2012, and December 31, 2024, and had postoperative radiologic follow-up by computed tomography (CT). The primary outcome was radiologic hernia recurrence. Secondary outcomes included 30-day complications and postoperative weight trajectory. Between-group comparisons used Fisher’s exact or χ2 tests for categorical variables and Welch t-test or Mann-Whitney U test for continuous variables, as appropriate; two-sided p < 0.05 was considered significant.ResultsFifty-two patients (mean BMI 45.0 ± 5.4 kg/m2), 80.8% female, met the inclusion criteria. Radiologic recurrence occurred in 9 patients (17.3%; CI 9.4%–29.7%) at a median imaging follow-up of 793 days (IQR 412–1381) in the overall cohort. Recurrence was observed exclusively in incisional (2/16, 12.5%) or recurrent incisional hernias (7/21, 33.3%) (p = 0.028), with no recurrences in primary hernias (0/15). 30-day complications occurred in 11.5% of patients. Patients with recurrence experienced significantly greater postoperative weight loss than those without (15.6% vs. 4.6% of total body weight; p = 0.015). Operative technique and mesh-related variables were not significantly associated with recurrence (all p > 0.25), although the study was underpowered to detect such associations.ConclusionMinimally invasive VHR in patients with class III obesity was associated with low short-term morbidity, but the mid-term radiologic recurrence rate of 17.3% is on the higher end of published estimates and should not be characterized as low. Recurrence occurred exclusively in incisional and recurrent incisional hernias, reaching 24.3% when primary hernias were excluded; associations with technical factors and BMI were not statistically significant in this small sample. Greater postoperative weight loss was associated with recurrence, though reverse causation and ascertainment bias cannot be excluded. Given the small sample size, these findings are hypothesis-generating and warrant confirmation in larger, prospective studies.