Abdominal wall procedures: the benefits of prehabilitation

Abstract

Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications. It includes interventions that optimize nutrition, glycemic control, functional status, and utilization of the patient's microbiome pre-, intra-, and postoperatively. Through a multidisciplinary and anticipatory approach to patients' existing co-morbidities, the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting. With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay, it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction. Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.

The influence of a multidisciplinary team meeting and prehabilitation on complex abdominal wall hernia repair outcomes

“…Previous studies have demonstrated that SSOs occur mainly in patients having a high-risk characteristic at the time of surgery [ 7 – 9 ]. Numerous studies have unambiguously reported that preoperative smoking, obesity, or a low physical activity level influence incisional hernia repair negatively, in terms of SSO and recurrence [ 10 – 15 ].…”

Don't fear the (small) bite: A narrative review of the rationale and misconceptions surrounding closure of abdominal wall incisions

“…Optimization of patient related risk factors requires, in theory, long pre-planning and screening before surgery rendering preoperative optimization extremely difficult for most cases. Scientific interest in “Prehabiliation” programs prior to major abdominal surgery increases of late and first studies show promising results in reducing overall and pulmonary morbidity ( 16 ) but definitive clinical effectiveness is currently very limited ( 17 ), especially regarding wound complications ( 18 , 19 ). Hopefully, in the future, more research in this area will allow further reduction of postoperative wound-related morbidity.…”

Complex abdominal wall hernias

“…A quality control cycle was initiated by applying the Plan-Do-Check-Act (PDCA) cycle and outcome evaluation at least once a year during a general meeting (65)(66)(67). Finally, a complex hernia care pathway was drafted.…”

“…After an era of focusing at enhanced recovery after surgery (ERAS), accent shifted several years ago to the preoperative setting (62). Preoperative identification of modifiable risk factors (prehabilitation) enables patient optimization and improves postoperative outcome, also in complex hernia patients (63)(64)(65)(66)(67)(68)(69).…”