INTRODUCTION: Prehabilitation in the context of abdominal wall repair has received increasing interest as a strategy to improve postoperative outcomes by focusing on optimizing preoperative risk factors. The main approach includes nutritional counseling, exercise, and psychological intervention. The aim of this project was to assess whether a multimodal prehabilitation program for patients scheduled to undergo large ventral incisional hernia repair could modify the risk factors and optimize them for surgery. In addition, the impact on postoperative outcomes was evaluated. PATIENTS AND METHODS: This retrospective analysis included patients referred to a multimodal prehabilitation program preceding complex abdominal wall repair for incisional hernia between 2016 and 2020. The program comprised medical optimization, supervised and home-based exercise training, personalized nutrition plans, smoking cessation counseling, and psychological support. Patients were deemed optimized if they met one of the recommended criteria: weight loss ≥ 7% of total body weight, smoking cessation, or Hemoglobin A1c <
7%. Perioperative care adhered to an Enhanced Recovery After Surgery (ERAS) pathway. Primary outcome was the number of patients reaching optimization criteria preoperatively. Secondary outcomes included functional capacity changes from baseline (six-minute walk test), length of stay, and postoperative complications. RESULTS: Seventy consecutive patients were analyzed, with 57.1% completing the program (prehabilitation group) and 42.9% not (dropout group). Groups were similar in baseline characteristics. In the prehabilitation group, 27.5% were fully optimized, 45% partially optimized, and 82.5% underwent surgery, while 30% partially met criteria and 33.3% underwent surgery in the control group. Patients showed functional improvement (mean + 61 m in 6MWT), with no significant differences in postoperative outcomes. CONCLUSION: Prehabilitation positively impacted modifiable risk factors in hernia patients, aiding in their eligibility for complex abdominal wall surgery. Patients participating in the program experienced enhanced functional capacity, indicating the potential benefits of prehabilitation in optimizing surgical outcomes.