Study population text

Adults (≥ 18 years) with obesity (BMI ≥ 30 kg/m²) and an elective primary ventral or incisional midline hernia of European Hernia Society width W2-W3, amenable to a standard Rives-Stoppa retromuscular repair, managed at four high-volume abdominal wall surgery units. The prospective prehabilitation cohort comprises consecutive eligible patients who agreed to undergo a structured 16-week tirzepatide-based preoperative weight-optimization program before elective repair. The comparative control cohort comprises patients meeting the same age, BMI, hernia type, EHS width, and surgical-technique criteria who underwent elective repair without pharmacologic prehabilitation at the same centers over the preceding five years, identified from prospectively maintained institutional databases. Patients requiring emergency surgery, posterior component separation/transversus abdominis release, or with contraindications to tirzepatide were not included.