Postoperative Work and Activity Restrictions After Abdominal Surgery: A Systematic Review

OBJECTIVE

This systematic review aims to assess what is known about convalescence following abdominal surgery. Through a review of the basic science and clinical literature, we explored the effect of physical activity on the healing fascia and the optimal timing for postoperative activity.

BACKGROUND

Abdominal surgery confers a 30% risk of incisional hernia development. To mitigate this, surgeons often impose postoperative activity restrictions. However, it is unclear whether this is effective or potentially harmful in preventing hernias.

METHODS

We conducted 2 separate systematic reviews using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The first assessed available basic science literature on fascial healing. The second assessed available clinical literature on activity after abdominal surgery.

RESULTS

Seven articles met inclusion criteria for the basic science review and 22 for the clinical studies review. The basic science data demonstrated variability in maximal tensile strength and time for fascial healing, in part due to differences in layer of abdominal wall measured. Some animal studies indicated a positive effect of physical activity on the healing wound. Most clinical studies were qualitative, with only 3 randomized controlled trials on this topic. Variability was reported on clinician recommendations, time to return to activity, and factors that influence return to activity. Interventions designed to shorten convalescence demonstrated improvements only in patient-reported symptoms. None reported an association between activity and complications, such as incisional hernia.

CONCLUSIONS

This systematic review identified gaps in our understanding of what is best for patients recovering from abdominal surgery. Randomized controlled trials are crucial in safely optimizing the recovery period.

Comparison of ıncisional hernia models ın rats: an experimental study

PURPOSE

Incisional hernia repair is a frequently performed operation worldwide. In this experimental study, our aim is to present the incisional hernia model after creating midline laparotomy and several type of defects on abdominal wall of the rats. Thereby, the method determined here may be used in future experimental incisional hernia repair studies.

METHODS

After approval, 32 male rats were randomly seperated into 4 groups of 8 animals each, and were operated to form an incisional hernia; Sham group, 5 cm incision group, 5 cm incision plus capitonnage group, and 5 cm incision plus 2 × 4 cm muscle excision group, respectively. On the 28th postoperative day after killing, the abdominal anterior wall of rats were removed for histopathological and biomechanic examination.

RESULTS

The incisional hernia size was found to be statistically different in at least one group (p = 0.001). The incisional hernia size in Group 4 was found to be significantly higher than Group 2 (p = 0.001). When the tension and elongation values were examined, there was a difference in at least one group (p < 0.001 and p = 0.029, respectively). Histopathological examination shows that the degree of inflammation and fibrosis varies significantly (p = 0.001 and p = 0.002, respectively).

CONCLUSION

This study has lead us to believe that the rat model created by applying muscle excision from the midline of the abdomen is the ideal incisional hernia model that can be used in future experimental incisional hernia studies.

A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard^®, Prolene^® or biodegradable Surgisis^® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

Bovine fetal collagen reinforcement in a small animal model of hernia with component repair

BACKGROUND

Component separation is a surgical strategy used to achieve abdominal wall reconstruction for patients with significant ventral hernias. With an increasing number of variations in procedural techniques and materials, the development of a small animal model of this surgery would allow for the controlled evaluation of variables with analytics not available in human clinical studies. To test this model, we investigated the reinforcement of these component repairs in rats with a bovine fetal collagen (BFC) scaffold.

METHODS

Fifty Sprague Dawley rats were randomized into either component repair alone or BFC reinforced component repair. At time points up to 1 y, these groups were evaluated for hernia formation, strength of repair, strength of mesh-muscle interface, and histology of the repair site.

RESULTS

Anterior component separation was achievable and reproducible in this small animal model. Significantly fewer hernias were found in BFC reinforced repairs. The change in transverse abdominal length was lower for reinforced repairs indicating less external oblique retraction, and reinforced repairs were consistently stronger than controls through 1 y. BFC was revascularized and repopulated with host cells but not rapidly degraded.

CONCLUSIONS

This small animal model of hernia repair with anterior component separation was effective in evaluating the reinforcement of a hernia repair with mesh. It may be useful in future work for the controlled, comparative investigation of different repair techniques and mesh materials in anterior component separation hernia repairs. Additionally, bovine fetal collagen was found to effectively reinforce component repairs and undergo an assimilation process including rapid revascularization and repopulation with host cells followed by gradual extracellular matrix remodeling.