Pre-habilitation in complex hernia surgery: protocol of an academic hospital

Abstract

Complex ventral hernias represent a significant technical and logistical challenge due to high morbidity and associated comorbidities, such as diabetes, obesity and sarcopenia. These patients usually present a significant decrease in their quality of life and functional capacity, which limits their baseline conditions and compromises their postoperative prognosis. In this context, pre-habilitation has emerged as a pro-mising multidisciplinary strategy that aims to optimize modifiable risk factors, integrating interventions in physical conditioning, nutritional support and smoking cessation. This strategy reduces postoperative complications and facilitates early functional recovery, promoting effective and early reintegration.

This local protocol, developed in an academic hospital, describes a standardization of comprehensive and collaborative preoperative management, involving surgical, anesthesiology, nutrition and physical therapy teams. In the pre-admission period, the patient undergoes a surgical, nutritional, anesthetic and physical evaluation. During the preoperative period, priority is given to nutritional optimization and physical con-ditioning. Intraoperatively, the protocol details the surgical and anesthetic approach to ensure adequate closure of the hernial defect. Finally, postoperative recovery is described with a program of physical therapy, early nutrition, analgesic management, and thromboembolic disease prophylaxis.

The present protocol aims to standardize the management of patients with complex hernias through an evidence-based approach, promoting optimal surgical results, reducing complications and improving the patient’s quality of life after surgery.