Practices in prehabilitation and follow-up after hernia surgery: a global survey of 135 surgeons from 20 countries.

INTRODUCTION

Despite being one of the most common procedures worldwide, with over 20 million cases annually, hernia repair overall continues to pose persistent challenges to clinicians. Challenges such as recurrence, chronic pain, and surgical site infections. Aside from surgical technique, preoperative optimization and postoperative follow-up can influence patient outcomes. However, practices vary widely and are influenced by practice type and patient-level barriers.

METHODS

We conducted a cross-sectional survey of practicing surgeons worldwide through Facebook hernia and abdominal wall surgery groups. The anonymous survey assessed existing prehabilitation programs, follow-up, and perceived limitations to optimal care.

RESULTS

A total of 145 surgeons from 22 countries participated. Of these, 58% were abdominal wall and hernia specialists and 44% practiced in dedicated hernia centers. Overall, 74% routinely recommended prehabilitation and 66% did so for all patients. The most common components were weight loss, smoking cessation, and glycemic control. Surgeons in hernia centers were more likely to recommend smoking cessation (p = 0.005), diabetes control (p = 0.04), and exercise (p = 0.03). Specialists more frequently recommended prehabilitation in more than 75% of ventral hernia cases (p = 0.001) and atypical hernias (p < 0.001). Hernia society membership was the only independent predictor of routine prehabilitation recommendation (OR 6.30; 95% CI 1.56-29.58; p = 0.01). Regarding postoperative follow up, 50% reported a standardized protocol for all hernias and 30% for high risk or complex cases only. Follow up was primarily in-person 77%. Hernia centers more frequently reported longer term follow up of 1-5 years for inguinal (p = 0.02), umbilical (p = 0.03), and non-complex ventral hernias (p < 0.001), as well as life-long follow up across hernia types. Abdominal wall and hernia specialty was independently associated with standardized follow-up protocols (OR 4.74; 95% CI 1.36-18.1; p = 0.017).

CONCLUSION

Prehabilitation and follow-up remain heterogeneous with adherence limited by the combination of patient, surgeon, and system-level barriers. Differences in practices between high- and low-volume surgeons suggest opportunities for society-driven guidance, extending standardized protocols, and deploying adherence tools to improve consistency and outcomes.