Evidence-based assessment of the period of physical inactivity required after inguinal herniotomy

Abstract

Since herniotomy is one of the most frequent surgical procedures, the socioeconomical impact of guidelines for convalescence is substantial; at the same time, the introduction of mesh techniques as standard procedure has led to a marked decrease in recurrence rates. Therefore, a reappraisal of guidelines concerning convalescence is warranted. This study is a comprehensive review of the literature including all levels of evidence. If an inguinal hernia is repaired with an appropriate technique in a surgically and technically faultless contemporary procedure, it is fully stable immediately after surgery. Therefore, pain is the only rational limiting factor for physical activities after the intervention. If a patient wishes to go back to work or other activities early, there is no reason to not facilitate this via a generous prescription of analgesics. Even hard physical work can technically be resumed after complete healing of the skin wound, and prolonged sick leave is neither necessary nor beneficial. No interrelation between physical activity after herniotomy and recurrence rate has yet been demonstrated; a randomized controlled trial might finally clarify this question, but at a substantial effort. The periods of inactivity practiced by patients and recommended by GPs are widely arbitrary and basically much too long, leading to unnecessary expenditures with an estimated order of magnitude of several hundred million euros per year in Germany. To reduce this surplus, guidelines should be implemented by the surgical professional associations and communicated intensively towards GPs and patients.