Hello,
Statistically, less than 2% of people with more than 30lbs of excess weight are ever able to lose that weight and keep it off without surgery. At 40, with a BMI of 46, you are at an excellent stage of life to get surgery, as you stand to gain a lot in quality of life and reduction in medical problems.

With your hernia, I usually do not fix them, unless they are very small. There is a two-fold rationale for this. The first is because it is impractical to fix them with mesh when also doing a bariatric operation, because of increased risk of infection. Without mesh, there is a high likelihood of recurrence. That risk goes down substantially after weight loss. The second reason is that the umbilical hernia can be used to justify excess skin removal to your insurance company after weight loss. Without an umbilical hernia, most insurance companies will not pay for excess skin removal, or abdominoplasty.

Good luck with your journey!

Dr Dan