10 Jul 2025 Ozempic: A Game-Changer in Hernia Surgery!

Commonly known as the weight-loss injection, Ozempic has truly shaken things up since its introduction! In this blog post, I explain how this drug has changed the landscape of abdominal wall and hernia surgery.

Ozempic, whose active ingredient is semaglutide, is a medication administered subcutaneously once a week. It belongs to the class of GLP-1 receptor agonists and works by mimicking natural hormones in the body. It was originally developed for the treatment of type 2 diabetes. It is especially effective in patients who cannot achieve adequate blood sugar control with standard medications like metformin. In addition to lowering blood sugar, it is also preferred in patients with a history of heart attack or stroke due to its cardiovascular protective effects.

Its mechanism of action involves increasing insulin secretion from the pancreas, reducing glucagon production, and slowing gastric emptying. This process extends the feeling of fullness and suppresses appetite, which is why a ‘side benefit of weight loss’ is often observed in diabetic patients. It is important to note that Ozempic is a serious drug that must be used under physician supervision.

After this general information, I want to focus on its use in abdominal wall and hernia surgery, which is the main purpose of my article. I had already shared detailed information on ‘Hernia Surgery in Obese’ in a previous blog post. One of the most critical factors that directly affects the success of incisional hernias is obesity. In obese patients, the risk of postoperative complications and recurrence increases. We use Body Mass Index (BMI) to classify obesity. According to this metric, the more obese the patient is, the higher the risk of complications and recurrence. Conversely, the more obesity is reduced and controlled, the lower the rate of recurrence and complications.

Incisional hernias are challenging and complex. Increased intra-abdominal pressure due to obesity, delayed tissue healing, and technical difficulties make surgery risky. These patients need to be very well prepared before surgery; the most important point among these is that they should lose weight if they are overweight. However, simply telling the patient to go lose weight and come back is not enough. Most patients cannot achieve this or fail to lose enough weight. Advising them to follow up with a dietitian and exercise is easy, but for patients—especially the elderly—this can be difficult. Incisional hernias also grow over time, making matters even worse. Now, thanks to these new-generation drugs, patients lose weight rapidly and become better prepared for surgery in a shorter time. These medications offer a dual benefit in hernia surgery: by reducing intra-abdominal pressure and tension through weight loss, the rate of primary fascial closure, the main goal in incisional hernia repair, increases. Additionally, better control of diabetes as evidenced by decreased HbA1C results in fewer postoperative infections and improved wound healing.

In practice, treatment should start 3–6 months before surgery to reach the target weight, with progress monitored periodically, and hernia repair planned once the goal is achieved. I want to insert a quick note here: since Ozempic delays gastric emptying, it may pose an anesthesia risk. Therefore, it should be discontinued one week before surgery.

In many abdominal wall surgery centers across Europe and the United States with which we maintain close relationships, it is now used routinely. In our clinic, our approach is to put these patients on a 3-month Ozempic treatment plan for weight loss, and then proceed with surgery. We now offer this protocol as an option to our patients. On average, these patients lose 10–15 kg during this period. Of course, we have supportive protocols: patients should exercise to preserve muscle mass and take vitamin supplements.

Previously, for patients with incisional hernias and especially with morbid obesity with a BMI over 40, we would refer them directly to bariatric surgery and plan the hernia operation a year later. We have now updated this approach and are managing a large portion of these patients with Ozempic-induced weight loss, and our results are very good.

My prediction for Ozempic and similar medications is that their use will become widespread, especially in reducing obesity. As obesity improves, so will insulin resistance, metabolic syndrome, and type 2 diabetes. New versions of these drugs and oral formulations will become common. Probably, just as lifelong medication is used for type 2 diabetes today, this class of drugs will also be used in the same way. Currently, the single most effective method for morbid obesity is bariatric surgery. However, in the not-too-distant future, with the development of advanced versions of this group of drugs, even these surgeries may become obsolete.