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.
Trisca R, Oprea V, et al. • Hernia : the journal of hernias and abdominal wall surgery • 2026
Perioperative abdominal wall exercise rehabilitation reduces disability, increases abdominal function, and significantly shortens convalescence period after Lichtenstein tension-free groin hernia repair, with rehabilitation patients returning to work approximately 3.5 days earlier than controls.
Key Findings
Results
Patients receiving perioperative physical rehabilitation returned to work significantly earlier than controls after Lichtenstein hernia repair.
Rehabilitation group returned to work in 9.28 ± 4.47 days versus 12.86 ± 5.16 days in the control group (p < 0.001)
This represents approximately a 3.5-day reduction in convalescence period
194 patients were analyzed, 97 per group, in a prospective randomized case-control study conducted between January 1, 2023, and December 31, 2024
Return to work was the primary endpoint of the study
Results
Rehabilitation significantly reduced hernia-induced disability as measured by the Pain Disability Index (PDI) by postoperative day 7.
PDI reduction by day 7 was markedly more pronounced in the rehabilitation group (18.48 ± 4.31 vs. 13.59 ± 3.83; p < 0.001)
A higher proportion of rehabilitation patients achieved the Minimal Important Change in PDI (61 vs. 42; p = 0.006)
Preoperatively, the study group had higher baseline disability (PDI 56.7 ± 2.51 vs. 53.05 ± 2.74; p < 0.001), making the greater improvement even more notable
PDI (Pain Disability Index) was used to assess hernia-induced disability preoperatively and at 7 and 30 days postoperatively
Results
Abdominal wall functionality was better preserved and superior in the rehabilitation group compared to controls at both postoperative day 7 and day 30.
Preoperatively, the study group had lower abdominal wall functionality (AWF 5.15 ± 1.4 vs. 6.48 ± 1.34; p < 0.001)
By day 7, AWF scores decreased significantly in controls (p < 0.001), while the study group maintained stability, reaching significantly higher mean AWF scores (7.77 ± 1.02 vs. 7.29 ± 0.92; p < 0.001)
The rehabilitation group demonstrated superior functional recovery by day 30 (p = 0.01)
Abdominal wall functionality was evaluated using clinically validated tests: Trunk Raising (TR), Double Leg Lowering (DLL), and a Total Score (TS) calculated as the sum of TR and DLL
Results
Control group patients experienced significantly higher acute postoperative pain scores during mobilization at 24 hours after surgery.
At 24 hours postoperatively, the control group experienced significantly higher VAS scores, particularly during mobilization (p < 0.001)
Baseline preoperative pain levels were similar between groups (p = 0.937)
Acute postoperative pain was recorded at 24 and 72 hours using the Visual Analogue Scale (VAS)
The difference in acute pain between groups was measured specifically during mobilization, suggesting rehabilitation may confer early analgesic or functional benefit
Results
Multivariate regression identified preoperative PDI, functionality score, and symptom onset as independent predictors of both acute pain and early return to work.
All three predictors — preoperative PDI, functionality score, and symptom onset — were statistically significant (p < 0.05)
These variables were independent predictors for both acute postoperative pain and early return to work
This finding suggests that the preoperative clinical status is an important determinant of postoperative outcomes
Results
The perioperative rehabilitation protocol was safe, with no recurrences and no significant differences in complication rates between groups during follow-up.
During a mean follow-up of 18.4 ± 3.6 months, no recurrences were reported in either group
Minor complications including hematoma, seroma, and chronic pain showed no significant differences between groups (p > 0.05)
The study enrolled patients with primary unilateral reducible non-scrotal groin hernias only
The safety profile of the rehabilitation protocol was confirmed across the full follow-up period
Methods
The study population had notable baseline differences between groups despite randomization, with the rehabilitation group having higher preoperative disability and lower abdominal functionality.
Study group had higher preoperative PDI (56.7 ± 2.51 vs. 53.05 ± 2.74; p < 0.001)
Study group had lower preoperative AWF scores (5.15 ± 1.4 vs. 6.48 ± 1.34; p < 0.001)
Baseline pain levels were similar between groups (p = 0.937)
Participants were stated to be 'blindly randomised according to rehabilitation' into study and control groups
Baseline parameters recorded included age, gender, BMI (kg/m²), comorbidities, and symptom onset
What This Means
This research suggests that adding a structured exercise program before and after inguinal (groin) hernia surgery can meaningfully speed up recovery. The study followed 194 patients who underwent a common open hernia repair operation called the Lichtenstein procedure. Half the patients participated in a physical rehabilitation program involving abdominal wall exercises, while the other half received standard care without a formal exercise program. The researchers measured pain, disability, abdominal muscle function, and how quickly patients were able to return to work.
Patients who participated in the exercise rehabilitation program returned to work about 3.5 days sooner on average (roughly 9 days versus nearly 13 days). They also experienced less disability and better abdominal muscle function by one week after surgery, and these advantages persisted at the one-month follow-up. Notably, the non-rehabilitation group reported significantly more pain during movement in the first 24 hours after surgery. Importantly, the rehabilitation program appeared safe — there were no hernia recurrences in either group over an average follow-up of about 18 months, and rates of minor complications like bruising, fluid collections, or chronic pain were similar between the two groups.
This research suggests that incorporating a structured perioperative exercise program into the standard care pathway for groin hernia surgery could help patients recover faster and return to normal activities and work sooner, without increasing the risk of complications. The findings also indicate that a patient's level of disability and abdominal function before surgery are important predictors of how quickly they will recover, highlighting the potential value of prehabilitation — preparing patients physically before an operation — as part of surgical care.
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Trisca R, Oprea V, Toma M, Cadar I, Bucuri C, Finascu F, et al.. (2026). 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.. Hernia : the journal of hernias and abdominal wall surgery. https://doi.org/10.1007/s10029-026-03729-0