Postoperative Work and Activity Restrictions After Abdominal Surgery: A Systematic Review
Abstract
Objective: This systematic review aims to assess what is known about convalescence following abdominal surgery. Through a review of the basic science and clinical literature, we explored the effect of physical activity on the healing fascia and the optimal timing for postoperative activity. Background: Abdominal surgery confers a 30% risk of incisional hernia development. To mitigate this, surgeons often impose postoperative activity restrictions. However, it is unclear whether this is effective or potentially harmful in preventing hernias. Methods: We conducted 2 separate systematic reviews using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The first assessed available basic science literature on fascial healing. The second assessed available clinical literature on activity after abdominal surgery. Results: Seven articles met inclusion criteria for the basic science review and 22 for the clinical studies review. The basic science data demonstrated variability in maximal tensile strength and time for fascial healing, in part due to differences in layer of abdominal wall measured. Some animal studies indicated a positive effect of physical activity on the healing wound. Most clinical studies were qualitative, with only 3 randomized controlled trials on this topic. Variability was reported on clinician recommendations, time to return to activity, and factors that influence return to activity. Interventions designed to shorten convalescence demonstrated improvements only in patient-reported symptoms. None reported an association between activity and complications, such as incisional hernia. Conclusions: This systematic review identified gaps in our understanding of what is best for patients recovering from abdominal surgery. Randomized controlled trials are crucial in safely optimizing the recovery period.
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The abdominal surgery literature regarding postoperative activity is limited; a recent systematic review identified only 2 randomized trials.
“The abdominal surgery literature regarding postoperative activity is limited. A recent systematic review of activity restrictions after abdominal surgery identified only 2 randomized trials.5,6,7”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [5]
Cites
A Comparison of Suture Repair with Mesh Repair for Incisional Hernia
Luijendijk, R. W., Hop, W. C. J., van den Tol, M. P., Lange, D., Braaksma, M., IJzermans, J. N. M., Boelhouwer, R. U., Vries, B. C. D., Salu, M. K. M., Wereldsma, J. C. J., et al. (2000) · New England Journal of Medicine · doi:10.1056/nejm200008103430603 · Cited by 1,872 · see citing works
Burger, J. W. A., Luijendijk, R. W., Hop, W. C. J., Halm, J. A., Verdaasdonk, E. G. G., & Jeekel, J. J. (2004) · Annals of Surgery · doi:10.1097/01.sla.0000141193.08524.e7 · Cited by 1,615 · see citing works
Epidemiology and cost of ventral hernia repair: making the case for hernia research
Poulose, B. K., Shelton, J. S., Phillips, S. E., Moore, D. E., Nealon, W. H., Penson, D. F., Beck, W. C., & Holzman, M. D. (2011) · Hernia · doi:10.1007/s10029-011-0879-9 · Cited by 920 · see citing works
The Healing of Rat Skin Wounds
Levenson, S. Μ., Geever, E. F., CHOWLEY, L. V., OATES, J. F., Berard, C. W., & ROSEN, H. (1965) · Annals of Surgery · doi:10.1097/00000658-196502000-00019 · Cited by 478 · see citing works
Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications
Holihan, J. L., Alawadi, Z. M., Martindale, R. G., Roth, J. S., Wray, C. J., Ko, T. C., Kao, L. S., & Liang, M. K. (2015) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2015.04.026 · Cited by 287 · see citing works
Self-citationThe Biology of Hernia Formation
Franz, M. (2008) · Surgical Clinics of North America · doi:10.1016/j.suc.2007.10.007 · Cited by 212 · see citing works
Self-citationDuBay, D. A., Choi, W., Urbanchek, M. G., Wang, X. B., Adamson, B., Dennis, R. G., Kuzon, W. M., & Franz, M. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000251267.11012.85 · Cited by 154 · see citing works
Self-citationFactors Determining Convalescence After Uncomplicated Laparoscopic Cholecystectomy
Bisgaard, T. (2001) · Archives of Surgery · doi:10.1001/archsurg.136.8.917 · Cited by 144 · see citing works
Physical Activity and its Influence on the Repair Process of Medial Collateral Ligaments
VAILAS, A. C., Tipton, C. M., MATTHES, R. D., & Gart, M. (1981) · Connective Tissue Research · doi:10.3109/03008208109160237 · Cited by 133 · see citing works
van der Meij, E., Anema, J. R., Leclercq, W. K. G., Bongers, M. Y., Consten, E. C. J., Schraffordt Koops, S. E., van de Ven, P. M., Terwee, C. B., van Dongen, J. M., Schaafsma, F. G., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31113-9 · Cited by 114 · see citing works
Measurement of the tensile strength of the ventral abdominal wall in comparison with scar tissue
Hollinsky, C., & Sandberg, S. (2006) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2006.06.002 · Cited by 109 · see citing works
Activity vs. rest in the treatment of bone, soft tissue and joint injuries.
Buckwalter, J. A. (1995) · PubMed Central · Cited by 103 · see citing works
Convalescence after inguinal herniorrhaphy.
Bay-Nielsen, M., Thomsen, H., Andersen, F. H., Bendix, J. H., Sørensen, O. K., Skovgaard, N., & Kehlet, H. (2004) · British Journal of Surgery · doi:10.1002/bjs.4437 · Cited by 101 · see citing works
Current practice of abdominal wall closure in elective surgery – Is there any consensus?
Rahbari, N. N., Knebel, P., Diener, M. K., Seidlmayer, C., Ridwelski, K., Stöltzing, H., & Seiler, C. M. (2009) · BMC Surgery · doi:10.1186/1471-2482-9-8 · Cited by 85 · see citing works
The Role of Wound Healing and Its Everyday Application in Plastic Surgery
Ireton, J. E., Unger, J. G., & Rohrich, R. J. (2013) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0b013e31828ff9f4 · Cited by 76 · see citing works
Inoue, M., Woo, S. L., Gomez, M. A., Amiel, D., Ohland, K. J., & Kitabayashi, L. R. (1990) · Connective Tissue Research · doi:10.3109/03008209009009809 · Cited by 65 · see citing works
Fascial incisions heal faster than skin: A new model of abdominal wall repair
Franz, M., Smith, P. D., Wachtel, T. L., Wright, T. E., Kuhn, M. A., Ko, F., & Robson, M. C. (2001) · Surgery · doi:10.1067/msy.2001.110220 · Cited by 63 · see citing works
Self-citationEarly laparotomy wound failure as the mechanism for incisional hernia formation
Xing, L., Culbertson, E. J., Wen, Y., & Franz, M. (2012) · Journal of Surgical Research · doi:10.1016/j.jss.2012.09.009 · Cited by 58 · see citing works
Self-citationvan Vliet, D. C., van der Meij, E., Bouwsma, E. V. A., Noordegraaf, A. V., van den Heuvel, B., Meijerink, W. J. H. J., van Baal, W. M., Huirne, J. A. F., & Anema, J. R. (2016) · Surgical Endoscopy · doi:10.1007/s00464-016-4931-9 · Cited by 57 · see citing works
Noordegraaf, A. V., Anema, J., Louwerse, M., Heymans, M. W., van Mechelen, W., Brölmann, H., & Huirne, J. A. F. (2013) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12494 · Cited by 53 · see citing works
Carney, M. J., Weissler, J. M., Fox, J. P., Tecce, M. G., Hsu, J. Y., & Fischer, J. P. (2017) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2017.01.001 · Cited by 51 · see citing works
Early return to work after repair of a unilateral inguinal hernia
Taylor, E. W., & Dewar, E. P. (1983) · British journal of surgery · doi:10.1002/bjs.1800701010 · Cited by 48 · see citing works
Mueller, M. G., Lewicky-Gaupp, C., Collins, S. A., Abernethy, M. G., Alverdy, A., & Kenton, K. (2017) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000001924 · Cited by 46 · see citing works
Advice given to patients about return to work and driving following surgery
Clayton, M., & Verow, P. (2007) · Occupational Medicine · doi:10.1093/occmed/kqm063 · Cited by 43 · see citing works
Shubinets, V., Fox, J. P., Lanni, M. A., Tecce, M. G., Pauli, E. M., Hope, W. W., Kovach, S. J., & Fischer, J. P. (2018) · The American Surgeon · doi:10.1177/000313481808400132 · Cited by 42 · see citing works
Bouwsma, E. V. A., Huirne, J. A. F., van de Ven, P. M., Noordegraaf, A. V., Schaafsma, F. G., Koops, S. E. S., van Kesteren, P. J. M., Brölmann, H. A. M., & Anema, J. R. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-017781 · Cited by 41 · see citing works
Bouwsma, E. V. A., Bosmans, J. E., van Dongen, J. M., Brölmann, H. A. M., Anema, J. R., & Huirne, J. A. F. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-017782 · Cited by 38 · see citing works
Questionnaire Analysis of Recovery of Activities of Daily Living After Laparoscopic Surgery
Kikuchi, I., Takeuchi, H., Shimanuki, H., Kitade, M., Kumakiri, J., Kuroda, K., Kobayashi, Y., & Takeda, S. (2008) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2007.08.606 · Cited by 35 · see citing works
A retrospective study of return to work following surgery
Clayton, M., & Verow, P. (2007) · Occupational Medicine · doi:10.1093/occmed/kqm082 · Cited by 35 · see citing works
Return to work and sick leave after radical prostatectomy: A prospective clinical study
Dahl, S., Steinsvik, E. A. S., Dahl, A. A., Loge, J. H., Cvancarova, M., & Fosså, S. D. (2013) · Acta Oncologica · doi:10.3109/0284186x.2013.844357 · Cited by 32 · see citing works
Culbertson, E. J., Xing, L., Wen, Y., & Franz, M. (2011) · Surgery · doi:10.1016/j.surg.2011.06.011 · Cited by 31 · see citing works
Self-citationPostoperative-treatment following open incisional hernia repair: A survey and a review of literature
Paasch, C., Anders, S., & Strik, M. W. (2018) · International Journal of Surgery · doi:10.1016/j.ijsu.2018.04.014 · Cited by 30 · see citing works
No consensus on restrictions on physical activity to prevent incisional hernias after surgery
Pommergaard, H., Burcharth, J., Danielsen, A. K., Angenete, E., Haglind, E., & Rosenberg, J. (2013) · Hernia · doi:10.1007/s10029-013-1113-8 · Cited by 26 · see citing works
Convalescence after laparoscopic inguinal hernia repair: a qualitative systematic review
Tolver, M. A., Rosenberg, J., & Bisgaard, T. (2016) · Surgical Endoscopy · doi:10.1007/s00464-016-4863-4 · Cited by 26 · see citing works
Low Job Satisfaction Predicts Delayed Return to Work After Laparoscopic Cholecystectomy
Froom, P., Melamed, S., Nativ, T., Gofer, D., & Froom, J. (2001) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-200107000-00014 · Cited by 24 · see citing works
Hospital stay and return to full activity following laparoscopic colorectal surgery.
Raymond, T. M., Dastur, J. K., Khot, U., & Parker, M. C. (2008) · PubMed Central · Cited by 24 · see citing works
Raymond, T., Kumar, S., Dastur, J. K., Adamek, J. P., Khot, U., Stewart, M., & Parker, M. (2009) · Colorectal Disease · doi:10.1111/j.1463-1318.2009.01925.x · Cited by 23 · see citing works
Arunachalam, D., & Heit, M. H. (2020) · International Urogynecology Journal · doi:10.1007/s00192-020-04239-y · Cited by 20 · see citing works
Assessing factors influencing return back to work after cholecystectomy: a qualitative research
Keus, F., Vries, J. D., Gooszen, H. G., & van Laarhoven, C. J. H. M. (2010) · BMC Gastroenterology · doi:10.1186/1471-230x-10-12 · Cited by 19 · see citing works
Bouwsma, E. V. A., Anema, J. R., Noordegraaf, A. V., de Vet, H. C. W., & Huirne, J. A. F. (2017) · BMC Surgery · doi:10.1186/s12893-017-0317-8 · Cited by 19 · see citing works
Brölmann, H. A. M., Noordegraaf, A. V., Bruinvels, D. J., de Vet, R. H. C., Dirksz, A. A., & Huirne, J. A. F. (2009) · Surgical Endoscopy · doi:10.1007/s00464-008-0287-0 · Cited by 18 · see citing works
Evidence-based assessment of the period of physical inactivity required after inguinal herniotomy
Buhck, H., Untied, M., & Bechstein, W. O. (2012) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-012-1008-7 · Cited by 18 · see citing works
Tensile Properties of the Murine Ventral Vertical Midline Incision
Carlson, M. A., & Chakkalakal, D. A. (2011) · PLoS ONE · doi:10.1371/journal.pone.0024212 · Cited by 12 · see citing works
von Mechow, S., Graefen, M., Haese, A., Tennstedt, P., Pehrke, D., Friedersdorff, F., & Beyer, B. (2018) · Urologic Oncology Seminars and Original Investigations · doi:10.1016/j.urolonc.2018.02.006 · Cited by 12 · see citing works
Partoune, A., Coimbra, C., Brichant, J., & Joris, J. (2017) · Acta Chirurgica Belgica · doi:10.1080/00015458.2017.1279871 · Cited by 10 · see citing works
Loor, M. M., Dhanani, N. H., Trautner, B. W., Hughes, T. G., Schwartz, J., Wei, Q., & Liang, M. K. (2020) · Surgery · doi:10.1016/j.surg.2020.05.035 · Cited by 9 · see citing works
Self-citationAn Experimental Animal Model for Abdominal Fascia Healing after Surgery
Burcharth, J., Pommergaard, H., Klein, M. F., & Rosenberg, J. (2013) · European Surgical Research · doi:10.1159/000353970 · Cited by 5 · see citing works
Mueller, M. G., Lewicky‐Gaupp, C., Collins, S., Abernethy, M., Alverdy, A., & Kenton, K. S. (2017) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000000462 · Cited by 4 · see citing works
Beyer, B., von Mechow, S., Tennstedt, P., & Graefen, M. (2017) · European Urology Supplements · doi:10.1016/s1569-9056(17)30983-1 · Cited by 2 · see citing works
Boettge, K. R., Croner, R. S., Lefering, R. L., Lorenz, E. P. M., & Paasch, C. (2020) · International Journal of Surgery Protocols · doi:10.1016/j.isjp.2020.05.001 · Cited by 2 · see citing works
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Frassini, S., Cobianchi, L., Fugazzola, P., Biffl, W. L., Coccolini, F., Damaskos, D., Moore, E. E., Kluger, Y. S., Ceresoli, M., Coimbra, R. S. M., et al. (2023) · World Journal of Emergency Surgery · doi:10.1186/s13017-023-00511-w · Cited by 37 · see citing works
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O’Shea, M., Siddiqui, N. Y., Truong, T., Erkanli, A., & Barber, M. D. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2023.1649 · Cited by 16 · see citing works
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Zeineddin, S. A., Figueroa, A., Pitt, J. B., Carter, M. M., DeTella, M., Perez, A., Park, E., Kwon, S., Ghomrawi, H., & Abdullah, F. (2023) · Journal of Surgical Research · doi:10.1016/j.jss.2023.10.020 · Cited by 7 · see citing works
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Cano, M. L., Hernández-Granados, P., Morales‐Conde, S., Ríos, A., & Pereira, J. A. (2024) · Cirugía Española · doi:10.1016/j.ciresp.2024.01.003 · Cited by 6 · see citing works
Mizusawa, Y., Noda, H., Ichida, K., Fukai, S., Matsuzawa, N., Tamaki, S., Abe, I., Endo, Y., Fukui, T., Takayama, Y., et al. (2023) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-023-03193-9 · Cited by 5 · see citing works
Safety of core muscle training immediately after abdominal surgery: systematic review
Perrodin, S. F., Salm, L., & Beldi, G. (2023) · BJS Open · doi:10.1093/bjsopen/zrad142 · Cited by 4 · see citing works
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Cano, M. L., Hernández-Granados, P., Morales‐Conde, S., Ríos, A., & Pereira, J. A. (2024) · Cirugía Española (English Edition) · doi:10.1016/j.cireng.2024.01.005 · Cited by 3 · see citing works
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Cacheiro, A., Philip, C. E., Francis, G., da Silva, P. H. C. M., Koski, C., Murphy, L. S.-L., Alzogaray, V., & Chang, O. H. (2024) · Urogynecology · doi:10.1097/spv.0000000000001622 · Cited by 3 · see citing works
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Lai, E., McDonald, K., Chopra, V., Robinson, L. E., Alvarez, A., O’Shaughnessy, D. L., Pillalamarri, N., Polland, A. R., Shalom, D. F., & Winkler, H. A. (2024) · Urogynecology · doi:10.1097/spv.0000000000001515 · Cited by 2 · see citing works
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Moreno, C. G. (2023) · Springer eBooks · doi:10.1007/978-3-031-26614-0_10
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Woeste, G. (2024) · Springer eBooks · doi:10.1007/978-3-662-68686-7_66
de Cauter, J. V., Motmans, J., VELDE, D. V. D., & Braeckman, L. (2025) · International Journal of Transgender Health · doi:10.1080/26895269.2024.2447754
Bellato, V., Blackwell, S. E., Elhadi, M., Grove, T., Massey, L. H., Vieira, B., Denys, A., Pata, F., van Ramshorst, G. H., 2024 European Society of Coloproctology (ESCP) Collaborating Group, et al. (2025) · Hernia · doi:10.1007/s10029-025-03493-7
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Ali, A., Miller, T.-A., Waters, C., Kim, S., & Lian, X. (2026) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000001112
Valkenet, K., van der Velde, M., Bor, P., Geleijn, E., Otte, W. M., Heijnen, G. H., Kerst, A., Roest, A.-M. P.-V., Bijl, R., Marsman, M., et al. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100954
Araújo, M. A. D. S., Souza, A. C. D. C., de Paula, A. S. V., Oliveira, B., Montenegro, J. V., Teixeira, J. G., & Oliveira, M. F. S. (2026) · Research Society and Development · doi:10.33448/rsd-v15i8.51574
- Authors
- Loor, M. M., Shah, P., Olavarria, O. A., Dhanani, N., Franz, M. G., Trautner, B. W., & Liang, M. K.
- Affiliations
- Baylor College of Medicine (US)
- Lyndon Baines Johnson Hospital (US)
- University of Central Florida (US)
- Michael E. DeBakey VA Medical Center (US)
- University of Houston (US)
- Corresponding author
- Loor, Michele M.
- Trautner, Barbara W.
- Liang, Mike K.
- Venue
- Annals of Surgery
- Published
- 2020-12-18
- Volume
- 274
- Issue
- 2
- Pages
- 290-297
- ISSN
- 0003-4932 (ISSN-L)
- 1528-1140
- OpenAlex
- W3114290150
- Cited by
- 21
- References
- 50
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 1
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- abdominal surgery, postoperative activity restrictions, convalescence, incisional hernia, physical activity, return to activity, wound healing, postoperative recovery
- MeSH terms
- Abdomen, Activities of Daily Living, Humans, Postoperative Care, Postoperative Period, Quality of Life, Wound Healing, Recovery of Function, Return to Work
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