Early structured rehabilitation following open retromuscular incisional hernia repair: a prospective randomized controlled trial.

Introduction: Incisional hernias remain a common postoperative problem for general surgeons. In recent years, early postoperative rehabilitation has gained increasing attention as a potential strategy to enhance recovery following abdominal wall reconstruction. This study aimed to evaluate whether structured early postoperative rehabilitation improves objectively measured abdominal wall and trunk muscle functional recovery after open retromuscular (Rives-Stoppa) incisional hernia repair while maintaining postoperative safety.

Materials and methods: Thirty adults undergoing elective open retromuscular (Rives-Stoppa) repair of European Hernia Society W2 incisional hernias were randomized to structured postoperative rehabilitation (n = 15) or standard postoperative care (n = 15). Baseline and approximately 2-month postoperative trunk muscle performance were assessed using Biodex dynamometry. The rehabilitation program consisted of supervised, progressive exercises initiated at postoperative week 3 and delivered according to the standardized study protocol. The primary analyses compared individual patient-level changes in trunk flexor and extensor peak torque between groups at angular velocities of 60°/s and 90°/s using the Mann-Whitney U test. Secondary outcomes included additional dynamometric parameters and postoperative clinical outcomes.

Results: Thirty patients were included in the analysis. Between-group comparisons demonstrated a statistically significant difference only for the change in trunk flexor peak torque at 90°/s, favoring the rehabilitation group (Δ + 34.3 vs. - 3.8 N·m; Mann-Whitney U = 80.0, p = 0.023). Between-group differences were not statistically significant for trunk flexor peak torque at 60°/s (p = 0.081), trunk extensor peak torque at 60°/s (p = 0.224), or trunk extensor peak torque at 90°/s (p = 0.254). Because four primary peak-torque comparisons were performed without adjustment for multiplicity, the isolated statistically significant finding should be interpreted cautiously. No apparent increase in postoperative complications was observed in the rehabilitation group. Two recurrences occurred during the 12-month follow-up, both in the control group. However, the study was not powered to evaluate recurrence.

Conclusions: Structured early postoperative rehabilitation was associated with a greater improvement in trunk flexor peak torque at 90°/s compared with standard postoperative care. No statistically significant between-group differences were observed for the other assessed peak-torque outcomes. Given the small sample size, baseline imbalances, multiple unadjusted comparisons, and effort-dependent nature of dynamometric testing, the findings should be considered exploratory and hypothesis-generating. Larger adequately powered randomized trials incorporating patient-centered outcomes are required.