Risk Factor-Driven Prehabilitation Prior to Abdominal Wall Reconstruction to Improve Postoperative Outcome. A Narrative Review

Abstract

All abdominal wall reconstructions find themselves on a scale, varying between simple to highly complex procedures. The level of complexity depends on many factors that are divided into patient comorbidities, hernia characteristics, and wound characteristics. Preoperative identification of modifiable risk factors provides the opportunity for patient optimization. Because this so called prehabilitation greatly improves postoperative outcome, reconstructive surgery should not be scheduled before all modifiable risk factors are optimized to a point where no further improvement can be expected. In this review, we discuss the importance of preoperative risk factor recognition, identify modifiable risk factors, and utilize options for patient prehabilitation, all aiming to improve postoperative outcome and therewith long-term success of the reconstruction.

Keywords: abdominal wall reconstruction; hernia repair; prehabilitation; review; risk factors.

FIGURE 1

Cross-sectional CT images from the same patient at approximately the same transverse level, when discussed for surgery at the outpatient clinic (A), and about 5 weeks after bilateral intramuscular injection with botulinum toxin (B). The pretreatment flattened and elongated the lateral abdominal wall muscles, and reduced the hernia diameter.