The Relation between the Distance of Recto-Fascial Plication and the Intra-Abdominal Pressure Changes before and Immediately after Abdominoplasty

Abstract

Background: Abdominoplasty surgery involves excisionof redundant abdominal skin flap and, in most cases, involvesrestoring weakened anterior abdominal wall muscles creatingan abdominal profile that is smoother and firmer. Diastasisrecti caused by anterior abdominal wall weakness. It happensbecause the space between left and right recti muscles hasbeen widened. Surgical correction for diastasis during theabdominoplasty can be considered as a definitive way forcorrection of diastasis by performing a plication or foldingof the linea alba, this results in a tighter abdominal wall.Aim of Work: Is to evaluate the relationship between thedistance of recto-fascial plication and intra-abdominal pressure(IAP) changes before and immediately after abdominoplasty.Patient and Methods: This study included 75 femalepatients, ageing between 24-57 years old, with mean age of43.3 years. Patients complained of abdominal redundancyafter childbirth, or post massive weight loss, with weak anteriorabdominal wall muscles. The diastasis width was measuredintraoperatively at three levels (3cm above the umbilicus, atthe umbilicus, and 3cm below the umbilicus) before performingrecto-fascia plication. Recto-fascial plication have beenperformed for all patients during their abdominoplasty procedurein two layers. Intra-abdominal pressure (IAP) variation,before and immediately after rectus sheath plication weremeasured using U-tube technique. Statistical analysis of allmeasurements were done.Results: Statistical analysis showed that the mean valueof diastasis above and at the umbilicus didn't differ significantly,however it was significantly lower below the umbilicuscompared with the other two levels. Comparing the pre andpostoperative IAP showed non-statistically significant increaseof IAP postoperative. Most importantly, statistics showed thatthere is a statistically significant positive correlation betweenthe IAP immediately after surgery and the distance of rectofascialplication especially above the umbilicus. Complicationrate in the current study was 2.6%.Conclusion: As a result of our current study, rectus diastasiswidth is significantly correlated with the IAP immediatelyafter abdominoplasty, therefore the larger the width of therectus diastasis, the more increase of IAP that would happenimmediately after abdominoplasty.