Postoperative Activity Restrictions After Reconstructive Pelvic Surgery

Objectives: The clinical benefit of postoperative activity restrictions following pelvic reconstructive surgery is widely accepted yet not well-established in evidence-based medicine. In this meta-analysis, we aim to evaluate the existing literature that compares anatomical and functional outcomes for liberal postoperative activity versus standard of care after reconstructive pelvic surgery.

Methods: PubMed, CENTRAL, Scopus, Web of Science, and CINAHL databases were searched for trials published up to December 2023 with no language restrictions. Search terms used include “urogynecologic surgery”, “sacrocolpopexy”, “midurethral sling”, “postoperative care” and “physical activity”, some adjusted to each database, as required. We analyzed randomized controlled trials and observational studies, with a focus on objective and subjective surgical outcomes such as anatomic success, patient satisfaction, and quality of life indicators post-surgery. Two review authors independently screened the titles and abstracts based on the previously defined eligibility criteria. The studies included recent works from multiple authors, with a critical risk of bias assessment informing the validity of the findings per Cochrane recommendations. Statistical analysis was performed using RevMan Web software. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity.

Results: Out of 1476 database results, 16 studies were eligible for full-text review. A total of 6 studies, all randomized trials, were included, 2 of which were on mid-urethral slings and 4 focused on prolapse repair with and without concomitant incontinence procedures. Post-operative follow-up ranged from 6 weeks to 1 year. Data from four studies suggest no significant difference between liberal and standard postoperative instructions in objective prolapse surgical outcomes (Mean Difference [MD] -0.07, 95% CI -0.20 to 0.05, p=0.24). Disease-specific symptom distress, measured by Pelvic Floor Distress Inventory-20, favored the liberal approach (MD -8.41, 95% CI -15.71 to -1.11, p=0.02). Other domains such as urinary distress (UDI-6) and colorectal-specific quality of life (CRAIQ-7) also showed significant improvements with liberal post-operative activities (MD -3.23, 95% CI -6.65 to 0.18, p=0.06; MD -3.14, 95% CI -5.81 to -0.48, p=0.02, respectively).

Conclusions: In this systematic review, liberal postoperative activity instructions may be non-inferior to standard restrictions regarding anatomic outcomes, with potential benefits in disease-specific symptom relief and quality of life. These findings support a potential shift toward more liberal postoperative regimens in pelvic reconstructive surgery, although further research is needed to confirm these preliminary results.