About this trial
The current practice to avoid incisional hernia, one of the most frequent complications following abdominal surgery, is to minimize core muscle activity in the postoperative phase. However, there is no evidence to support the association of core muscle activity and increased incidence of incisional hernia. On the contrary, it is likely that reduced physical activity could lead to physical deconditioning, chronic postsurgical pain (CPSP), and sarcopenia. The investigators will conduct a prospective multicentric randomized clinical trial to compare standard of care to core muscle exercises targeting the abdominal muscles immediately postsurgery. The principle hypothesis is that neither specific exercises of core muscles before and after surgery nor physical restriction alter the incidence of incisional hernias. Secondly the impact of postoperative rehabilitation on CPSP and sarcopenia will be assessed.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Informed Consent as documented by signature (Appendix Informed Consent Form)
Age > 18 years
Capable of judgment
Undergoing elective or emergency abdominal surgery
Disqualifiers
Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders (chronic depression, under antidepressants or neuroleptics), dementia, etc. of the participant
Enrolment of the investigator, his/her family members, employees and other dependent persons
Neuromuscular diseases (such as myasthenia gravis or wheelchair-bound patient)
Preexisting chronic pain disorder, patients under chronic opioid therapy (WHO II and III) or pain modulating drugs (antidepressive medication or antiepileptic medication)
Trial design
Parallel
Treatments tested in this trial
Physiotherapy
Other intervention4 specific core muscle exercises, targeting abdominal muscles, to be performed daily from postoperative day one to 2 months postsurgery.
Treatment groups
Trial outcomes
Primary outcomes
Incidence of incisional hernia 24 months postsurgery
Incidence of incisional hernia diagnosed by ultrasound and clinical examination
Secondary outcomes
Incidence of Chronic postsurgical pain
Abdominal pain assessment by Visual Analog Scale (VAS). VAS score ranges from 0 (no pain) to 10 (worst possible pain). The mean VAS in the last 24 hours will be documented.
Exercise
Exercise type and number of repetitions
Length of hospital stay
Length of hospital stay
Readmission rate
Hospital readmission
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