"An abdominoplasty modification for post-pregnancy abdomen with rectus diastasis and midline hernia: the technique and results".

Abstract

Few women recover from pregnancy abnormally and end up having severe post-pregnancy rectus diastasis (RD) with body control dysfunction, midline hernia or other quality of life impairment. The purpose of this study was to describe the authors' experience using HELP modification of abdominoplasty (Hydrodissection and Epidural anesthesia for Lateral Plication) to restore abdominal wall firmness. 46 consecutive post-pregnancy RD patients were enrolled. The mean intraoperative inter rectus distance was 4.6 cm. RD is not always the only structure that has been elongated. Firmness of the abdominal wall depends also on lateral fascia structures. Our study reports the total plicated distance addressing the lateral laxity in the abdominal wall. In this series total plication was 7.8 cm. In this series 16 patients had a midline hernia. We did not see hernia recurrences, and the rectus bellies were <5mm apart from each other in all participants verified with ultrasound after two years of follow up. Patient perspective of care and surgical outcome were recorded: HRQoL domains were significantly higher postoperatively implicating better health. Lumbar back pain visual analogy scale score was 4.5±2.3 preoperatively and 0.5 ±0.9 postoperatively. The ability to perform sit-ups increased from 0 to 11 suggesting better motor control. Total complication rate was 10.9%. HELP modification seems to offer a reliable and effective treatment method for RD repair with and without a small midline hernia with low complication rate.