Rectus sheath plication in abdominoplasty: Assessment of its longevity and a review of the literature

Abstract

Correction of rectus diastasis during abdominoplasty is controversial. Few published studies have investigated the long-term value of plication. This prospective study aims to assess the long-term durability of plication of the rectus sheath in abdominoplasty using ultrasound. A total of 28 consecutive abdominoplasty patients underwent rectus plication by the senior author (FSF) since 2006, using a 0/0 looped nylon suture. Rectus diastasis was measured preoperatively and postoperatively at 3, 6 and 12 month's intervals using a standardised ultrasound (7.5 MHz) probe, by the single senior radiologist (GJD). Diastasis of the recti was assessed at three fixed points: at the umbilicus, 6 cm above and 6 cm below the umbilicus. Diastasis was categorised using the Beer classification. All patients were female with a mean age of 36 years and average of body mass index (BMI) 26 kg m(-2). The majority of subjects had previous abdominal surgery including caesarean sections (82%, n = 23) and had at least one previous pregnancy (87%), with only two patients (8.7%) in the study being nulliparous. Correction of diastasis was maintained in all patients despite previous pregnancies and abdominal surgery. Postoperative follow-up time averaged 28 months (range 12-43 months). According to the Beer classification, there was no recurrence of rectus diastasis at the 12-month postoperative ultrasound measurements. A significant reduction in the mean distance between rectus muscles before surgery and 12 months postoperatively was noted. Previous surgery did not have a statistically significant affect on preoperative rectus distance. Vertical rectus plication with a non-absorbable suture demonstrates long-term durable results without any suture-related complications. Patient factors such as extent of preoperative rectus diastases and previous abdominal surgery did not appear to have a significant effect on the durability of the corrected diastasis.