Respiratory physiotherapy in the prevention and recovery of pulmonary complications after upper abdominal surgery: a literature review

Abstract

Introduction: Postoperative pulmonary complications are among the most frequent adverse events after upper abdominal surgery and are associated with increased morbidity and mortality, prolonged hospital stay, and higher healthcare costs. Reduced lung volumes, diaphragmatic dysfunction, and incisional pain favor atelectasis and respiratory infections during the perioperative period. Objective: This study described the role of respiratory physiotherapy in preventing these complications and in the functional recovery of patients undergoing upper abdominal surgery. Methods: A narrative literature review, descriptive and qualitative in nature, was conducted. The search was performed in July 2026 in the following sources: Medical Literature Analysis and Retrieval System Online (MEDLINE), via PubMed; Scientific Electronic Library Online (SciELO); Latin American and Caribbean Health Sciences Literature (LILACS); Physiotherapy Evidence Database (PEDro); and the Cochrane Library, complemented by grey-literature screening in Google Scholar. Texts in Portuguese and English were considered, with no initial publication year limit. Selection was carried out by reading titles, abstracts and full texts. Results: The review included 23 sources published between 1983 and 2024. The synthesis of evidence indicates that preoperative interventions, particularly education combined with inspiratory muscle training and instruction in breathing exercises, consistently reduce the incidence of pulmonary complications. In the postoperative period, lung expansion techniques, breathing exercises, and early mobilization contribute to the recovery of pulmonary function, although the benefit of some isolated modalities, such as incentive spirometry, remains uncertain. Conclusion: Respiratory physiotherapy, especially when initiated preoperatively and integrated into enhanced recovery programs, represents a relevant component of perioperative care, and more rigorous trials are needed to establish the most effective protocols and the actual impact on functional recovery.