Connect the Dots—April 2017
Obstet Gynecol 2017;129:608–14
The postoperative instructions we typically give patients after abdominal surgery are pretty standard: no driving, no lifting, no sex, and no exercise for a period of time, typically 6 weeks. Mueller and colleagues report the results of a randomized controlled trial involving women undergoing minimally invasive pelvic reconstructive surgery (see p. 608). The groups were given exercise instructions that were similar, with the instruction that the intervention group was told to resume lifting, running, high-impact aerobic exercise, and sit-ups as soon as they felt strong enough, whereas the control group was advised to avoid these activities until 12 weeks postoperatively. Both groups were advised to walk and climb stairs ad lib and to avoid anything in their vaginas for 6 weeks. At the 12-week visit, validated questionnaires showed similar rates of exercise in both groups. The liberal exercise group had greater degrees of satisfaction with the advice provided, and at least one measure of the short-term surgical outcome was improved without any worsening of the surgical outcomes by any measure.
These authors asked a simple, important question and implemented a straightforward study to answer it. Although we certainly do not want to jeopardize surgical outcomes, liberalizing the recommendations for activity after minimally invasive surgery for prolapse seems to be a reasonable recommendation at this point. Because it would seem that women in the control group did not follow the advice, as they had the same level of exercise as the study group, it makes sense to provide evidence-based, realistic postoperative advice that is achievable by our patients.