Physiotherapy rehabilitation for pain, mobility, and return to activities after abdominal wall surgery: A literature review
DOI:
https://doi.org/10.62827/fb.v27i5.1237Keywords:
Postoperative care; Pain, postoperative; Early ambulation; Herniorrhaphy; Recovery of function.Abstract
Introduction: Abdominal wall surgery, which encompasses the repair of inguinal, ventral, and incisional hernias, complex abdominal wall reconstruction, and laparotomies, is among the most frequently performed procedures in surgical practice and is associated with pain, reduced mobility, and delayed return to daily and occupational activities. Objective: This study described the role of physiotherapy in pain control, mobility recovery, and return to activities in patients undergoing abdominal wall surgery. Methods: This is a narrative literature review. The search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), accessed through PubMed, Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), Physiotherapy Evidence Database (PEDro), and Cochrane Library. Guidelines, reviews, and clinical studies available in full text, in Portuguese, English, and Spanish, were included and analysed descriptively, organised into thematic axes. Results: International guidelines indicate that prolonged activity restriction after uncomplicated inguinal hernia repair is not necessary. Preoperative respiratory physiotherapy reduced pulmonary complications after major abdominal surgery. Early mobilization improved functional capacity and favoured gastrointestinal recovery, although its isolated effects on morbidity and length of stay were inconsistent. Transcutaneous electrical nerve stimulation reduced acute pain and analgesic consumption after inguinal hernia repair. Studies on abdominal wall stabilization exercises are scarce. Conclusion: Physiotherapy contributes to recovery after abdominal wall surgery through preoperative respiratory physiotherapy, early mobilization started within the first 24 hours, and transcutaneous electrical nerve stimulation as an adjuvant analgesic resource, delivered in the hospital setting and during outpatient follow-up, with individualized progression according to the type and magnitude of the repair.
References
HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi:10.1007/s10029-017-1668-x
Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, et al. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg. 2023 Nov 9;110(12):1732-1768. doi:10.1093/bjs/znad284
Vassilakopoulos T, Mastora Z, Katsaounou P, Doukas G, Klimopoulos S, Roussos C, et al. Contribution of pain to inspiratory muscle dysfunction after upper abdominal surgery: a randomized controlled trial. Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1372-1375. doi:10.1164/ajrccm.161.4.9907082
Ford GT, Whitelaw WA, Rosenal TW, Cruse PJ, Guenter CA. Diaphragm function after upper abdominal surgery in humans. Am Rev Respir Dis. 1983 Apr;127(4):431-436. doi:10.1164/arrd.1983.127.4.431
Alaverdyan H, Maeng J, Park PK, Reddy KN, Gaume MP, Yaeger L, et al. Perioperative risk factors for persistent postsurgical pain after inguinal hernia repair: systematic review and meta-analysis. J Pain. 2024 Sep;25(9):104532. doi:10.1016/j.jpain.2024.104532
Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023 Sep 5;7(5):zrad080. doi:10.1093/bjsopen/zrad080
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World J Surg. 2019 Mar;43(3):659-695. doi:10.1007/s00268-018-4844-y
Boden I, Skinner EH, Browning L, Reeve J, Anderson L, Hill C, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ. 2018 Jan 24;360:j5916. doi:10.1136/bmj.j5916
de Almeida EPM, de Almeida JP, Landoni G, Galas FRBG, Fukushima JT, Fominskiy E, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial. Br J Anaesth. 2017 Nov;119(5):900-907. doi:10.1093/bja/aex250
Barberan-Garcia A, Ubre M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg. 2018 Jan;267(1):50-56. doi:10.1097/SLA.0000000000002293
Goncalves CG, Groth AK. Prehabilitation: how to prepare our patients for elective major abdominal surgeries? Rev Col Bras Cir. 2019;46(5):e20192267. doi:10.1590/0100-6991e-20192267
Jensen KK, East B, Jisova B, López Cano M, Cavallaro G, Jørgensen LN, et al. The European Hernia Society Prehabilitation Project: a systematic review of patient prehabilitation prior to ventral hernia surgery. Hernia. 2022 Jun;26(3):715-726. doi:10.1007/s10029-022-02573-2
Liang MK, Bernardi K, Holihan JL, Cherla DV, Escamilla R, Lew DF, et al. Modifying risks in ventral hernia patients with prehabilitation: a randomized controlled trial. Ann Surg. 2018 Oct;268(4):674-680. doi:10.1097/SLA.0000000000002961
Willner A, Teske C, Hackert T, Welsch T. Effects of early postoperative mobilization following gastrointestinal surgery: systematic review and meta-analysis. BJS Open. 2023 Sep 5;7(5):zrad102. doi:10.1093/bjsopen/zrad102
Forgiarini Junior LA, Carvalho AT, Ferreira TS, Monteiro MB, Dal Bosco A, Gonçalves MP, et al. Atendimento fisioterapeutico no pos-operatorio imediato de pacientes submetidos a cirurgia abdominal. J Bras Pneumol. 2009 May;35(5):455-459. doi:10.1590/s1806-37132009000500011
Boden I, Reeve J, Jernås A, Denehy L, Fagevik Olsén M. Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data. J Physiother. 2024 Jul;70(3):216-223. doi:10.1016/j.jphys.2024.02.012
Soares SM, Nucci LB, da Silva MM, Campacci TC. Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial. Clin Rehabil. 2013 Jul;27(7):616-627. doi:10.1177/0269215512471063
Fernandes DL, Righi NC, Rubin Neto LJ, Bellé JM, Pippi CM, Ribas CZM, et al. Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial. J Bras Pneumol. 2022;48(1):e20210280. doi:10.36416/1806-3756/e20210280
Della Via F, Concon Filho A, Kosour C, Andrade CEF, Guedes E, Dragosavac D. Impacto de dois métodos de reexpansão pulmonar em pacientes submetidos a cirurgia bariátrica por videolaparoscopia. Fisioter Bras. 2021;22(1):37-48. doi:10.33233/fb.v22i1.4432
Viderman D, Nabidollayeva F, Aubakirova M, Sadir N, Tapinova K, Tankacheyev R, et al. The impact of transcutaneous electrical nerve stimulation (TENS) on acute pain and other postoperative outcomes: a systematic review with meta-analysis. J Clin Med. 2024;13(2):427. doi:10.3390/jcm13020427
Parseliunas A, Paskauskas S, Kubiliute E, Vaitekunas J, Venskutonis D. Transcutaneous electric nerve stimulation reduces acute postoperative pain and analgesic use after open inguinal hernia surgery: a randomized, double-blind, placebo-controlled trial. J Pain. 2021 May;22(5):533-544. doi:10.1016/j.jpain.2020.11.006
Schaaf S, Willms A, Schwab R, Güsgen C. Recommendations on postoperative strain and physical labor after abdominal and hernia surgery: an expert survey of attendants of the 41st EHS Annual International Congress of the European Hernia Society. Hernia. 2022;26(3):727-734. doi:10.1007/s10029-021-02377-w
Perrodin SF, Salm L, Beldi G. Safety of core muscle training immediately after abdominal surgery: systematic review. BJS Open. 2023;7(6):zrad142. doi:10.1093/bjsopen/zrad142
Adams ST, Bedwani NH, Massey LH, Bhargava A, Byrne C, Jensen KK, et al. Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence. Hernia. 2022;26(3):701-714. doi:10.1007/s10029-022-02562-5
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Rafael Viana dos Santos Coutinho , Yuri Martins Amorim, Gustavo Coelho Tafuri Mota, Igor Rabelo Silveira, Pedro Henrique Silveira Carvalho (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution 4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
Autores têm autorização para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
