ABDOMINAL RECTUS DIASTASIS (ARD) CORRECTION FOR PAIN REDUCTION AND IMPROVEMENT OF ABDOMINAL WALL MUSCLE STRENGTH

Abstract

Introduction: Rectus abdominis diastasis (RAD) can be described as a condition in which rectus abdominis muscles are separated by an abnormally wide distance i.e. any separation of more than 2 cm is considered to be abnormal. Several aetiological factors may lead to protrusion of the anterior abdominal wall. It is a common complaint in women after childbirth. Abdominal rectus diastasis (ARD) is a sequele of the expansion of the abdominal contents during pregnancy or massive weight loss and/or congenital disproportion of the collagen III/I ratio. Operative repair of ARD can improve abdominal wall function. Various methods for ARD repair have been described. These differ by approach like open versus laparoscopic, the position of suture placement, numbers of layers of sutures, suture material, and use of mesh. Also it can be combined with mesh augmentation in the IPOM technique for enhanced stabilization of the abdominal wall.
 Material and Methods: Eligible patients were randomized to either one of two operative procedures or a 3-month, dedicated training program which serve as a control group. ARD width was assessed clinically and confirmed with computed tomography scanning. Endpoints were assessed after 6 months for relapse of the ARD, pain, restriction of daily activities and improvement in muscle strength. Abdominal wall strengthe was assessed by Visual analogue scale (VAS).
 Results: A total of 72 patients were enrolled into the study (70 female and 2 male). 24 patients were enrolled in each group. 13 patients had undergone cesarean section in the Quill group and 12 in the mesh group. According to VAS scale no statistically significant difference was seen between the two operative groups regarding perceived improvement in abdominal wall strength. But it was significantly higher in operated group as compared to training group. Abdominal muscular strength was improved in all the three groups. Improvement in abdominal wall strength was lower in training group compared to operative groups. No relapse was observed in operative groups.
 Conclusion: Operative repair of ARD can provide functional stability and improvement in pain and physical parameters it also improves quality of life, and reduce functional disability.
 Keywords: ARD, Quill SRS, Mesh repair, VAS, linea alba (LA)