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.

内容摘要

Symptomatic groin hernias typically require surgical intervention, through either open or minimally invasive techniques. Among these, the Lichtenstein tension-free repair remains the gold standard for open procedures and is widely adopted today. Conventionally, patients are advised on convalescence and the timeline for resuming daily activities according with surgeons expertize. This study is based on the premise that structured physical rehabilitation can accelerate recovery and can facilitate an earlier return to work. Therefore, the goal was to evaluate the impact of a combined preoperative and post-operative exercise program as there is limited data that prehabilitation may decrease the period of convalescence. A prospective randomized case -control study was conducted between January 1, 2023, and December 31, 2024, enrolling patients with primary unilateral reducible non-scrotal groin hernias. Participants were blindly randomised according to rehabilitation in a study group (receiving physical rehabilitation) and a control group (without rehabilitation). Baseline parameters including age, gender BMI (kg/m2), comorbidities and symptoms onset were recorded for all participants. Preoperative hernia - induced disability was assessed using the Pain Disability Index (PDI).Abdominal wall functionality was evaluated through clinical validated tests: Trunk Raising (TR), Double Leg Lowering (DLL), and a Total Score (TS) calculated as the sum of TR and DLL. The assessments were performed preoperatively, as well as at 7 and 30 days postoperatively. Acute postoperative pain was recorded at 24 and 72&#xa0;h using the Visual Analogue Scale (VAS). The primary endpoint was the time to return to work, assessing the overall impact of rehabilitation on convalescence. A total of 194 patients (97 per group) were analysed. Preoperatively, the study group exhibited significantly higher disability (PDI 56.7&#x2009;&#xb1;&#x2009;2.51 vs. 53.05&#x2009;&#xb1;&#x2009;2.74; p&#x2009;<&#x2009;0.001) and lower abdominal functionality (AWF 5.15&#x2009;&#xb1;&#x2009;1.4 vs. 6.48&#x2009;&#xb1;&#x2009;1.34; p&#x2009;<&#x2009;0.001) compared to controls, with baseline pain levels remaining similar (p&#x2009;=&#x2009;0.937). Postoperatively, at 24&#xa0;h, the control group experienced significantly higher VAS scores, particularly during mobilization (p&#x2009;<&#x2009;0.001). By day 7, PDI reduction was markedly more pronounced in the rehabilitation group (18.48&#x2009;&#xb1;&#x2009;4.31 vs. 13.59&#x2009;&#xb1;&#x2009;3.83; p&#x2009;<&#x2009;0.001), with a higher proportion of patients achieving the Minimal Important Change (61 vs. 42; p&#x2009;=&#x2009;0.006). While AWF scores decreased significantly in controls by day 7 (p&#x2009;<&#x2009;0.001), the study group maintained stability, reaching significantly higher mean AWF scores (7.77&#x2009;&#xb1;&#x2009;1.02 vs. 7.29&#x2009;&#xb1;&#x2009;0.92; p&#x2009;<&#x2009;0.001) and superior functional recovery by day 30 (p&#x2009;=&#x2009;0.01). Crucially, the rehabilitation group returned to work significantly earlier (9.28&#x2009;&#xb1;&#x2009;4.47 vs. 12.86&#x2009;&#xb1;&#x2009;5.16 days; p&#x2009;<&#x2009;0.001). Multivariate regression identified preoperative PDI, functionality score, and symptom onset as independent predictors for both acute pain and early return to work (p&#x2009;<&#x2009;0.05). During a mean follow-up of 18.4&#x2009;&#xb1;&#x2009;3.6 months, no recurrences were reported, and minor complications (hematoma, seroma, chronic pain) showed no significant differences between groups (p&#x2009;>&#x2009;0.05), confirming the protocol's safety. Rehabilitation with physical therapy reduce disability, increase abdominal function and reduces the convalescence period after groin hernia repair in accordance with the actual guidelines.