Recommendations on Postoperative Activities After Abdominal Operations and Incisional Hernia Repair-A National and International Survey

Abstract

Background: There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and there is significant variation in the literature on that question. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery. Materials and Methods: A national (German) and international survey of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results: A total of 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p = 0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p = 0.000). Conclusion: There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socioeconomic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.

Keywords: abdominal surgery; enhanced recovery (ER); hernia surgery; incisional hernia; physical strain; postoperative activity.

Figure 1

Comparison of whether recommendations of postoperative activities are given to patients in case of laparotomy and laparoscopy. n/a, not answered. N = 385, p = 0.000 (chi-squared test).

Figure 2

Duration of postoperative recommendations. N = 295 for laparoscopy and n = 357 for midline and transverse laparotomy.

Figure 3

Given recommendations on weight lifting after laparotomy and laparoscopy.

Figure 4

Overview of recommendations on abdominal binders and sexual activity. Of those who recommend abdominal binders after laparotomy, 20.0% advise patients to wear them for 2 weeks, 23.5% for 4 weeks, and 27.2% for 6 weeks. n.a., not answered.

Figure 5

Comparison of survey results. The differences were statistically significant (p = 0.000; chi-squared test).