Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendo
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REVIEW
Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction J. E. Perez1 · M. A. Schmidt2 · A. Narvaez1 · L. K. Welsh1 · R. Diaz1 · M. Castro1 · K. Ansari3 · R. W. Cason3 · J. A. Bilezikian4 · W. Hope5 · A. D. Guerron1 · J. Yoo1 · H. Levinson3,6 Received: 27 April 2020 / Accepted: 2 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. Methods The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. Conclusions There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair. Keywords Ventral hernia · Prehabilitation · Physical therapy · Abdominal wall reconstruction · Anatomy · Patient-reported outcomes Juan Esteban Perez and Michael A. Schmidt have contributed equally to the article.
Introduction
* H. Levinson [email protected]
In 2006, there were more than 350,000 ventral hernia repairs (VHR) in the United States [1]. There is robust hernia literature on appropriate patient and mesh selection, how to perform surgeries, and how to optimize patients prior to surgery; however, interestingly, there are only a few articles on how to manage VHR patients post-operatively and even fewer articles discussing the role of physical therapy in the patient recovery. This gap in the literature is surprising given the fact that VHR is, in essence, a musculoskeletal reconstruction of the trunk, and physical therapy is known to play an important role in musculoskeletal rehabilitation. To better understand the role of physical therapy in VHR, this
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