Preoperative prehabilitation and postoperative mobilization in abdominal surgery: A narrative review

Abstract

Recovery after abdominal surgery involves functional capacity, complications, and independence, outcomes that do not necessarily respond similarly to perioperative interventions. This critical narrative review examines preoperative exercise, inspiratory muscle training, and postoperative mobilization in adults, distinguishing isolated interventions from multimodal programmes. Targeted PubMed searches were performed on October 15, 2026, supplemented by reference checking and examination of a specialty guideline. The analytical core used full texts to extract populations, comparators, outcomes, estimates, and limitations. Colorectal surgery trials yielded inconsistent complication results, whereas some identified improved functional recovery. In frail or high-risk patients, the reduction in severe complications observed across all studies in one review was not confirmed in the randomized trial subgroup. A small inspiratory training study included liver transplant recipients and donors and combined preoperative and postoperative training, limiting generalizability. Immediate mobilization improved oxygenation in one trial without conclusive reductions in complications or hospital stay. A 2026 review identified a possible reduction in pulmonary complications with early mobilization, but trial sequential analysis remained inconclusive. The 2025 colorectal guideline did not establish a specific prehabilitation regimen and retained mobilization recommendations supported by differing levels of evidence. Findings support outcome-specific and context-sensitive interpretation rather than a universal protocol or attribution of the entire perioperative pathway’s effects to a single component.