Rehabilitation after abdominal wall reconstruction: pain, muscle strength and return to exertion in a narrative review
DOI:
https://doi.org/10.62827/fb.v27i7.1234Keywords:
Hernia; Physical Therapy Modalities; Enhanced Recovery After Surgery; Activities of Daily Living; Return to Work.Abstract
Introduction: Abdominal wall reconstruction aims to restore fascial continuity and function, but pain, trunk weakness, and fear of exertion may persist beyond initial healing. Objective: To critically analyze evidence on pain, muscle strength, and return to exertion after abdominal wall reconstruction, emphasizing physiotherapy assessment and rehabilitation. Methods: Narrative review with a structured, descriptive, and qualitative search. Until July 10, 2026, Medical Literature Analysis and Retrieval System Online through PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, Physiotherapy Evidence Database, and Cochrane Library were consulted, supplemented by reference and citation tracking. Publications from 2021 to 2026 were prioritized without excluding seminal studies. Selection involved title and abstract screening followed by full-text reading according to predefined criteria. Because initial retrieval, duplicate, full-text, and exclusion counts were not preserved, they were not reconstructed retrospectively. Results: Twenty-three publications were included. Function tends to improve after midline restoration, but measurement instruments are heterogeneous. Pain and kinesiophobia were associated with poorer performance, and functional recovery showed an early decline followed by improvement during the first year. Evidence specific to supervised physiotherapy after ventral repair remains limited, and part of the interpretation depends on extrapolation. Conclusion: Rehabilitation should be individualized, guided by clinical and functional criteria, and integrated with the surgical team; evidence does not support universal loading protocols or the proven superiority of a specific physiotherapy program.
References
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;110(12):1732-68. doi:10.1093/bjs/znad284.
Smith OA, Mierzwinski MF, Chitsabesan P, Chintapatla S. Health-related quality of life in abdominal wall hernia: let's ask patients what matters to them? Hernia. 2022;26(3):795-808. doi:10.1007/s10029-022-02599-6.
Grove TN, Muirhead LJ, Parker SG, Brogden DRL, Mills SC, Kontovounisios C, et al. Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools. Hernia. 2021;25(2):491-500. doi:10.1007/s10029-020-02210-w.
Brucchi F, Gilardini R, Vetere A, Sassun R, Robecchi Majnardi A, Muysoms F, et al. Abdominal wall function in hernia and diastasis: systematic review of evaluation methods and clinical relevance. Hernia. 2026;30:79. doi:10.1007/s10029-025-03557-8.
Shen H, Farris D, Sanders DL, Dawes H, Lamb SE, Findlay JM. A scoping review of abdominal wall functional assessment in patients with hernias. Hernia. 2026;30:18. doi:10.1007/s10029-025-03517-2.
Arhos EK, Poulose BK, Di Stasi S, Chaudhari AMW. Individuals with a ventral hernia who report moderate to high fear have worse functional performance than those with low fear. Hernia. 2024;28(2):643-9. doi:10.1007/s10029-024-02979-0.
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):701-14. doi:10.1007/s10029-022-02562-5.
Di Stasi S, Chaudhari AMW, Renshaw S, Wei L, Ward L, Arhos EK, et al. ABVENTURE-P pilot trial of physical therapy versus standard of care following ventral hernia repair: protocol for a randomized controlled trial. PLoS One. 2023;18(7):e0289038. doi:10.1371/journal.pone.0289038.
Sánchez-Arteaga A, Gil-Delgado JL, Feria-Madueño A, Tallón-Aguilar L, Sañudo B, Padillo-Ruiz J. Impact of incisional hernia on abdominal wall strength. BJS Open. 2024;8(3):zrae045. doi:10.1093/bjsopen/zrae045.
Criss CN, Petro CC, Krpata DM, Seafler CM, Lai N, Fiutem J, et al. Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery. 2014;156(1):176-82. doi:10.1016/j.surg.2014.04.010.
Jensen KK, Munim K, Kjaer M, Jorgensen LN. Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life: a prospective controlled study. Ann Surg. 2017;265(6):1235-40. doi:10.1097/SLA.0000000000001827.
Toma M, Oprea V, Scarlat F, Bucuri CE, Andercou O, Mihaileanu F, et al. Quality of life and abdominal wall functionality after abdominal wall reconstruction: a prospective single center follow-up study. Hernia. 2024;28(6):2223-34. doi:10.1007/s10029-024-03143-4.
Head W, Kalsotra S, Yu M, Shannon K, Edwards P, Renshaw S, et al. Functional status after ventral hernia repair: longitudinal trends and the limits of improvement. J Am Coll Surg. 2026;243(1):60-9. doi:10.1097/XCS.0000000000001910.
Head W, Satija D, Shannon K, Edwards P, Renshaw S, Arhos E, et al. Is there a link between physical function testing and ventral hernia size? Surg Endosc. 2025;39(12):8572-9. doi:10.1007/s00464-025-12224-z.
Bravo-Ratón P, Santos-Sánchez JC, Gil-Delgado JL, Sánchez-Arteaga A, Tinoco-González J, Sañudo Corrales B, et al. Trunk muscle strength assessment as a predictor of complications in patients undergoing incisional hernia repair. Hernia. 2026;30:139. doi:10.1007/s10029-026-03621-x.
Gil-Delgado JL, Reverte-Pagola G, Pecci-Barea FJ, Feria-Madueño A, Sánchez-Arteaga A, Sañudo-Corrales B. Physical activity and exercise interventions in abdominal wall hernia patients: impact on quality of life and health outcomes: a systematic review and meta-analysis. Am J Phys Med Rehabil. 2025;104(6):519-26. doi:10.1097/PHM.0000000000002657.
Trisca R, Oprea V, Toma M, Cadar I, Bucuri CE, Finascu F, et al. The efectiveness of perioperative abdominal wall exercises upon functional recovery and return to work after Lichtenstein tension-free repair: a prospective randomized case-control study. Hernia. 2026;30:239. doi:10.1007/s10029-026-03729-0.
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.
Schaaf S, Schwab R, Güsgen C, Vilz TO, Willms A. Recommendations on postoperative activities after abdominal operations and incisional hernia repair: a national and international survey. Front Surg. 2021;8:713138. doi:10.3389/fsurg.2021.713138.
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;268(4):674-80. doi:10.1097/SLA.0000000000002961.
Bernardi K, Olavarria OA, Dhanani NH, Lyons N, Holihan JL, Cherla DV, et al. Two-year outcomes of prehabilitation among obese patients with ventral hernias: a randomized controlled trial (NCT02365194). Ann Surg. 2022;275(2):288-94. doi:10.1097/SLA.0000000000004486.
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;26(3):715-26. doi:10.1007/s10029-022-02573-2.
Souza TGMDE, Furtado SDC, Soares MCCX, Westphal FL. Perioperative management protocol for abdominal wall hernia repair in a public reference healthcare unit in Amazonas - Brazil. Rev Col Bras Cir. 2025;52:e20253820. doi:10.1590/0100-6991e-20253820-en.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Rafael Viana dos Santos Coutinho, Maria Fernanda Ferreira Pace, Rúbia Tauany Carneiro Lemos, Márcio Thadeu Assef Nunes Poggiali Gasparoni, Luiz Felipe Baratela Cuzzi (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.
