Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

August 27, 2020; Update January 19, 2022.

Avoid elective hernia repair for minimally symptomatic ventral hernias in patients with severe obesity without consideration for obesity management.

Obesity is an independent risk factor for complications following ventral hernia repair. These include longer length of hospital stay, surgical site infection, and recurrence. Ventral hernia patients with asymptomatic or mild symptoms that do not interfere with daily function may be at low risk for developing acute symptoms (bowel obstruction, strangulation). Patients with severe obesity and ventral hernias should be considered for multidisciplinary evaluation with the intent to improve their weight and related diseases, prior to proceeding with elective hernia repair.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


Liang MK, Holihan JL, Itani K, et al: Ventral Hernia Management, Expert Consensus Guided by Systemic Review. Annals of Surgery 2017;265(1):80-89

Holihan JL, Alawadi ZM, Harris JW, et al: Ventral hernia: Patient selection, treatment, and management. Current Problems in Surgery 2016;53:307-354