Postoperative Activity Restrictions After Reconstructive Pelvic Surgery.

Importance: Restrictive physical activity after pelvic reconstructive surgery is recommended, although the optimal duration and intensity are not standardized.

Objective: This systematic review and meta-analysis aimed to evaluate the existing literature comparing clinical outcomes for liberal postoperative physical activity versus standard of care, defined as restricted postoperative physical activity, after pelvic reconstructive surgery.

Study design: PubMed, CENTRAL, Scopus, Web of Science, and CINAHL databases were searched for observational and randomized studies comparing liberal postoperative physical activity and standard of care in women undergoing pelvic reconstructive surgery, reporting anatomic and functional outcomes. Statistical analysis was performed using RevMan software, presenting results as mean difference (MD) or odds ratio in a random-effects model, with 95% confidence intervals (CIs).

Results: Five randomized trials, representing total n = 434, were included, with 2 studies on sling surgical procedures and 3 on prolapse surgical procedures. Data from 3 studies suggest no significant difference between liberal and standard postoperative instructions in surgical outcomes, measured by Point Ba from POP-Q assessment tool, up to 3 months follow-up (MD, -0.04; 95% CI, -0.16 to 0.07; P = 0.49). Disease-specific symptom distress, measured by Pelvic Floor Distress Inventory-20, favored the liberal approach (MD, -10.09; 95% CI, -18.33 to -1.86; P = 0.02). Other domains, including Urinary Distress Inventory-6, also showed significant improvements with liberal postoperative activities (MD, -4.29; 95% CI, -7.84 to -0.74; P = 0.02).

Conclusions: Patients with liberal postoperative physical activity recommendations in prolapse repair surgical procedures had similar short-term anatomic outcomes compared with standard restrictions, with more favorable outcomes in disease-specific symptom relief and quality of life.