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Digestive Disease Interventions 2021; 05(03): 260-267
DOI: 10.1055/s-0041-1733885
Review Article

Prehabilitation and Nutrition in Hernia Surgery

Ramiro Cadena-Semanate
1   Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina
,
Ramon Diaz Jara
2   Advanced Gastrointestinal Surgery, Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile
,
Alfredo D. Guerron
1   Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina
,
Jin Yoo
1   Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina
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Abstract

Ventral hernia repair (VHR) is among the most frequently performed surgical procedures in the United States. Despite advancements in surgical technique, a significant number of VHR patients experience postoperative complications and hernia recurrence. A key strategy to reduce VHR morbidity is patient optimization before surgery with prehabilitation protocols. Prehabilitation aims to improve patients' functional status with physical conditioning, nutritional intervention, and psychological support. In other surgical disciplines, prompt preoperative action has proven to significantly reduce the negative influence of modifiable comorbidities and accelerate recovery. In this article, we review the literature to assess the applicability and benefits of prehabilitation in elective VHR cases. A review of the available evidence identified obesity, hyperglycemia, and smoking as significant modifiable risk factors that negatively affect VHR outcomes. Prehabilitation has the potential to mitigate and control these comorbidities. Physical conditioning with aerobic, resistance, and inspiratory muscle training is beneficial. Nutritional intervention to control diabetes and in severely malnourished patients is especially important in patients undergoing concomitant gastrointestinal procedures with VHR. Reasonable targets for prehabilitation protocols in elective VHR include a body mass index of 35 kg/m2, HbA1C of 6.5% and tobacco abstinence for at least 4 weeks. Prophylactic measures to minimize the rates of incisional hernia after primary laparotomy repairs include mesh reinforcement and a suture to wound length ratio of at least 4:1.

Keywords

prehabilitation - ventral hernia - physical conditioning - nutrition


Publication History

Received: 12 January 2021

Accepted: 23 June 2021

Article published online:
02 September 2021

© 2021. Thieme. All rights reserved.

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