Page 71 - Read Online

Knapp et al. Plast Aesthet Res 2020;7:7 Plastic and
DOI: 10.20517/2347-9264.2019.69 Aesthetic Research

Review Open Access

Abdominal wall procedures: the benefits of
prehabilitation

Nathan Knapp , Breanna Jedrzejewski , Robert Martindale 1
2
1
1 Division of Gastrointestinal and General Surgery Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA.

Correspondence to: Dr. Nathan Knapp, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd,
Portland, OR 97239, USA. E-mail: knappn@ohsu.edu

How to cite this article: Knapp N, Jedrzejewski B, Martindale R. Abdominal wall procedures: the benefits of prehabilitation. Plast Aesthet
Res 2020;7:7. http://dx.doi.org/10.20517/2347-9264.2019.69

Received: 6 Dec 2019 First Decision: 6 Feb 2020 Revised: 11 Feb 2020 Accepted: 12 Feb 2020 Published: 21 Feb 2020

Science Editor: Alexander F. Mericli Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract

Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical
complications. It includes interventions that optimize nutrition, glycemic control, functional status, and utilization of the
patient’s microbiome pre-, intra-, and postoperatively. Through a multidisciplinary and anticipatory approach to patients’
existing co-morbidities, the physiological stress of surgery may be attenuated to ultimately minimize perioperative
morbidity in the elective setting. With increasing data to support the efficacy of prehabilitation in optimizing surgical
outcomes and decreasing hospital length of stay, it is incumbent on the surgeon to employ these practices in elective
abdominal wall reconstruction. Further research on the effects of prehabilitation interventions will help to shape and
inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best
practices in surgical care.

Keywords: Prehabilitation, perioperative optimization, abdominal wall reconstruction, minimize co-morbidities

INTRODUCTION
Achieving optimal surgical outcomes for ventral hernia repairs (VHRs) is inherently challenging. Patients
who require complex reconstruction of the abdominal wall are commonly overweight, deconditioned,
malnourished with or without sarcopenia, and are often chronically infected/inflamed in the setting of
the previously placed synthetic mesh. Most patients in need of reconstruction have had prior repairs/

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.parjournal.net