STRONG prehabilitation before elective ventral hernia repair: Learnings from recruitment challenges in a randomized controlled trial

The impact of smoking, nutrition, alcohol, and physical inactivity (SNAP) on the outcome of ventral hernia repair remains underexplored. This trial aimed to evaluate the effect of targeted, intensive lifestyle prehabilitation on postoperative complications.

The STRONG-Hernia trial (NCT06611462) was a multicenter, parallel-group, centrally randomized controlled trial at two Danish university hospitals. Adults scheduled for elective ventral hernia repair with ≥1 risky SNAP factor were randomized (1:1) to STRONG prehabilitation or standard care. Prehabilitation comprised six weekly in-hospital sessions of education, motivational, and pharmaceutical support tailored to each patient's SNAP factors. The primary outcome was postoperative complications ≤30 days. Secondary outcomes included lifestyle changes and health-related quality of life (EQ-5D). Final primary outcome assessment and statistical analyses were blinded. Power calculation required inclusion of 2 × 199 patients.