Good evening. I am a currently practicing General Surgeon and also a lifter. Early in my career I was quite conservative with recommendations against lifting in postoperative patients. I would routinely recommend no strenuous lifting for 6-8 weeks. In recent years I have shaved that down to 4 weeks and try to tailor the restriction recommendations to the size and apparent fitness level of the patient. I really dislike telling my obese patients to take it easy for the next month, but at the same time, they can ill afford the complications that come with a ventral hernia, and many are already at higher risk of incisional infections and poor tissue healing due to their coincident diabetes, protein-calorie malnutrition, etc. For almost everyone, I recommend immediate resumption of routine daily physical activities such as daily evening walks or housecleaning. My particular patient population is heavily slanted toward an obese and largely sedentary community, often with comorbid conditions from the metabolic syndrome constellation; very few of my patients could be considered “fit” and many have a dozen chronic conditions or more. Despite this, I have not seen any significant increase in development of incisional hernias with the reduced period of lifting restriction. I am curious if that envelope can be pushed even further, but am reticent to get too aggressive without some additional data, which is not readily available. The best I’ve seen in a review of the topic by Schaaf, et. al. (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), but this is based mostly on OPINION of experts, not on hard data. Opinion there seems to be roughly evenly split between waiting 2 weeks vs 4 weeks for laparoscopic repairs and most seem to favor 4 weeks for open repairs. I’d really like to know your opinions on this and whether you’re aware of any better data to justify allowing an earlier return to strenuous activities.
Hey there,
Thanks for the post and thoughtful question. You may have seen the video I made regarding hernias with relevant citations: https://www.youtube.com/watch?v=E13KaMOiV6M
Regarding the question about additional data guiding decision making for physicians, I am not aware that direct data exists. The 2018 International Guidelines for Hernia Management recommend return to activity without restriction. I’m on board with that, as I think it is unlikely that folks will push things too hard, too fast given the typical pain and discomfort post-op. In short, I think it is unlikely that people will be participating in very strenuous gym-related activities within a few weeks of the procedure that exceeds the limits of the repair. I also do not think the risk of complication, dehiscence, etc. increases with activity vs. no activity post procedure. I also think the increased complication rate in some of your patient population is likely to be attenuated by getting them to exercise in the post-op period. We know that even a little bit of exercise seems to potentiate many different beneficial changes. Without evidence of harm, I’d have a tough time recommending against exercise.