Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias

Abstract

Diastasis recti is a common pathology during pregnancy and puerperium, usually associated with midline hernias, with aesthetic and symptomatic problems. This approach allows us to restore the alba line, without entering the abdominal cavity. Between April 2014 and July 2017, 50 patients underwent surgery, 94% female (mean age 38). Ultrasonography confirmed diagnosis. Recti diastasis was associated with midline defects in 100%. The preaponeurotic endoscopic repair is done with suprapubic approach and in both iliac fossae. A preaponeurotic new cavity was created with dissection of the subcutaneous cellular tissue and then recti plication with barbed suture was performed. The wall is reinforced with polypropylene mesh. Drainage is left systematically. Diastasis recti < 50mm (55.5%) was diagnosed, from 51 to 80mm (29.6%), and > 81mm (14.9%). Recti plication with bearded suture was performed. It was associated with external oblique release in 32% of patients, being unilateral (87.5%). Light/intermediate (90%) and heavy (10%) polypropylene meshes were placed, being fixed with absorbable (62%) and non-absorbable material (38%). Navel was reinserted using internal or external sutures. The average surgical time is 83min. There are no intraoperative complications, but PO seroma finding 12%. The average hospital stay was 1.3days, with pain level 3/10 according to AVS. The patients returned to their usual activities after 16.5 days. No complications or recurrences were observed by clinical and sonographic control at 18months in 74% of patients. The patients were followed up at 39 months. Patient satisfaction was reported as 96%. Diastasis recti is a common pathology with aesthetic and symptomatic problems. Endoscopic surgery allowed us to resolve the parietal defect with plication of recti and placement of preaponeurotic reinforcement prosthesis, increasing the safety of the repair, without entering the abdominal cavity, with a short hospitalization and no complications or recurrence in 3years.