Abdominal Diastasis Research Articles

11746 Integrating Precision and Efficiency: Robotic Hysterectomy and Correction of Abdominal Diastasis through the Same Abdominal Access

11746 Integrating Precision and Efficiency: Robotic Hysterectomy and Correction of Abdominal Diastasis through the Same Abdominal Access

Validation of a synthetic simulation model of endoscopic rectus sheath plication.

Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.

Economic value of diastasis repair with the use of mesh compared to no intervention in Italy

AimRectus abdominal diastasis (RAD) can cause mainly incontinence and lower-back pain. Despite its high incidence, there is no consensus regarding surgical indication. We aimed at comparing RAD repair (minimally invasive technique with mesh implant) with no treatment (standard of care – SOC) through cost-effectiveness and budget impact analyses from both National Healthcare Service (NHS) and societal perspectives in Italy.MethodsA model was developed including social costs and productivity losses derived by the online administration of a socio-economic questionnaire, including the EuroQol for the assessment of quality of life. Costs for the NHS were based on reimbursement tariffs.ResultsOver a lifetime horizon, estimated costs were 64,115€ for SOC and 46,541€ for RAD repair in the societal perspective; QALYs were 19.55 and 25.75 for the two groups, respectively. Considering the NHS perspective, RAD repair showed an additional cost per patient of 5,104€ compared to SOC, leading to an ICUR of 824€. RAD repair may be either cost-saving or cost-effective compared to SOC depending on the perspective considered. Considering a current scenario of 100% SOC, an increased diffusion of RAD repair from 2 to 10% in the next 5 years would lead to an incremental cost of 184,147,624€ for the whole society (87% borne by the NHS) and to incremental 16,155 QALYs.ConclusionIn light of the lack of economic evaluations for minimally invasive RAD repair, the present study provides relevant clinical and economic evidence to help improving the decision-making process and allocating scarce resources between competing ends.

Abdominal Diastasis, Conservative and Surgical Management

Abdominal diastasis is a condition that occurs when the rectus abdominis muscles separate, leading to weakness in the abdominal wall and can manifest as a bulge in the middle abdomen. Abdominal diastasis is a common condition that can generate annoying symptoms and affect the quality of life of those who suffer from it. Management of abdominal diastasis can include a variety of therapeutic approaches, from conservative management with specific exercises and manual therapy, to surgery in more severe cases.

Abdominal Diastasis, Conservative and Surgical Management

Abdominal Diastasis, Conservative and Surgical Management

V-008 RTARUP (ROBOTIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC) - «BOTTOM-UP APPROACH»

Abstract Robotic surgery is gaining more space in every country at every level. Wall surgery is one of the fields in which technology can help the surgeons and can give more opportunities to the patients. One of the biggest differences between laparoscopic surgery is that the use of the robot provides excellent 3D VISION of the abdomen and can ease the surgeon, during difficult and tricky situation mostly. One of this wall affection is diastasis recti. It affects about 1/3 of women after childbirth, yet it is still little talked about today. Often underestimated or confined to a cosmetic problem, most of the times abdominal diastasis is a functional problem primary and must be addressed in the correct way. In this video, we report a case of diastasis recti associated with a primary umbilical hernia in a multipara woman. She was 45 with a BMI of 26.4 kg/m2 and she came to our attention after a long period of discomfort and pain. She told us that her umbilical hernia was growing fast in the last months and that the condition of her abdomen was getting worse, with pain and digestive difficulties. At the physical examination we found an umbilical hernia of 3 cm of diameter and a diastasis recti of 6 cm of width. Due to the conditions of the patient, the young age and the will not to have children anymore, we decide to perform a robotic transabdominal retromuscular umbilical prosthetic (rTARUP) «bottom-up approach» (the patient never underwent abdominal surgery).

Applications of Pulsed Electromagnetic Field Therapy in Skeletal-Muscle System: An Integrative Review

Background: The Pulsed Electromagnetic Field (PEMF) technology has attracted increasing interest since consistent evidence of its therapeutic properties has been demonstrated to treat musculoskeletal conditions. However, this technology is not new, and has already been used in different experimental models and clinical studies for the treatment of tendinopathies, osteoarthritis, increased cell proliferation, bone consolidation, among others. Methods: In this work, we carried out an integrative review of clinical and experimental studies published in the last twenty years, on the available scientific evidence that demonstrate the effects of PEMF in different applications for health treatments. Five databases including Medline, Pubmed Central, Scopus, Lilacs and PEDro were searched for studies from 2001 to September 2022. The results were analyzed by the team of researchers and clinical professionals to assure methodological quality of the studies for the elaboration of the theoretical review on the effects of electromagnetic field stimulation on skeletal muscles, tendon or bones. Results: Sixty-two studies were included in this review, presenting evidence of the biological effects of PEMF that can suggest it´s possible use to treat different disorders. Conclusions: Pulsed electromagnetic fields (PEMF) present relevant clinical and experimental evidence of beneficial effects in the treatment of several musculoskeletal inflammatory disorders, such as tendinopathies and osteoarthritis, in addition to the treatment of urinary incontinence and abdominal diastasis. PEMF can be considered as the evolution of electrical currents for the treatment of musculoskeletal disorders, mainly due to its better tolerance by patients.

Pilates method and pain in pregnancy: a systematic review and metanalysis

ABSTRACT BACKGROUND AND OBJECTIVES: The bodily changes resulting from pregnancy can culminate in adverse outcomes to maternal health, including pain, which may be related to postural changes, functional disabilities and impaired quality of life of pregnant women. Due to its effects, the Pilates Method can contribute to alleviate these problems, although its benefits are not a consensus in the literature. In this sense, the objective of this study was to systematically review in the literature the implications of the Pilates Method on pain in pregnant women. CONTENTS: Systematic review and metanalysis of randomized clinical trials conducted in the databases Embase, Scopus, Cochrane Library, Medline, Web of Science, PEDro, LILACS and SciELO, where the descriptors “Pregnancy” and “Pilates Method” were used. Of the 105 articles found, five met the selection criteria for this study and two were included in the meta-analysis for the outcome pain. The Pilates Method group showed superiority for pain relief compared to the control group (CI95%: -2.24 - -1.13; I2: 12%). Additionally, the Pilates Method produced less progression of abdominal diastasis, decreased fatigue, maintained anthropometric and hemodynamic parameters, increased abdominal and pelvic floor strength, improved hamstring muscle flexibility, lumbar-pelvic stabilization, posture, functional capacity and quality of life of pregnant women. CONCLUSION: The Pilates method was superior to the minimum intervention for pain relief in pregnant women, in addition to improving physical conditions.

Hypopressive Abdominal Exercise in Postpartum Abdominal Diastasis

Hypopressive Abdominal Exercise in Postpartum Abdominal Diastasis

Abdominal Diastasis Repair by Robotic Surgery

Abdominal Diastasis Repair by Robotic Surgery

Abdominal Wall Plication and Correction of Deformities of the Myoaponeurotic Layer: Focusing on Materials and Techniques Used for Synthesis.

The different types of sutures utilized in plications and for correction of diastasis during abdominoplasty are reviewed and discussed. Because correction of abdominal deformities also involves fascia and muscle advancement, this review also covers the suture materials used in muscle advancement. The selection of specific techniques to treat different types of abdominal wall deformity is also considered. This is important, because the outcome when correcting these deformities depends not only on suture materials but also on employing the optimum technique. A PubMed/Medline search was performed with the following search terms: rectus diastasis, diastasis recti, diastasis recti abdominis, correction of rectus diastasis, abdominoplasty. Relevant articles identifying the type of suture (rapidly absorbable, slowly absorbable, nonabsorbable), monofilament or multifilament sutures, antibiotic-coated sutures, and barbed sutures were evaluated. In addition, articles about surgical technique comparing continuous and interrupted sutures, in both the anterior and posterior aponeurosis, to correct rectus diastasis are discussed. Efficacy of suture materials was evaluated based on the long-term results and recurrence rates reported in these articles. The current literature provides sufficient data to recommend a single-layer continuous suture, with slowly absorbable sutures of 0 polydioxanone or 2-0 nylon, for correction of abdominal diastasis. An interrupted triangular suture is a good alternative to correct the vertical elongation of the myoaponeurotic layer that occurs after pregnancy.

Does abdominal diastasis influence lumbar pain during gestation?

BACKGROUND AND OBJECTIVES: To evaluate and compare the presence and size of recti abdominis diastasis in the second and third gestational trimester and to correlate them to lumbar pain incidence and intensity. METHODS: This is a cross-sectional observational study with 128 pregnant women divided in two groups: 53 pregnant women in the second gestational trimester and 75 pregnant women in the third gestational trimester. Lumbar pain was evaluated with Roland Morris questionnaire and Pain Visual Analog Scale. Recti abdominis diastasis was measured with a caliper rule. Data were analyzed according to Spearman correlation and Mann-Whitney U test. RESULTS: Comparison between groups has shown that pregnant women in the third gestational trimester had more recti abdominis diastasis, more reports of severe lumbar pain by the visual analog scale (p=0.0017) and further impact on daily life activities (p=0.0012). There has been positive correlation between recti abdominis diastasis size and scores obtained by Roland Morris questionnaire and visual analog scale. CONCLUSION: Recti abdominis diastasis size, pain intensity and incapacity determined by low back pain were more severe in pregnant women in the third gestational trimester.

Prolotherapy Injections for Diastasis Recti: A Case Report

This case report detailed the history and treatment of a female postpartum patient with diastasis recti. Treatment for this patient included the use of prolotherapy, an injection-based therapy using dextrose as the active compound. The solution used during the course of therapy was composed of 6 mL of 50% dextrose, 3 mL of 1% lidocaine, and 1 mL of methylcobalamin (1000 mcg/mL). Injections were administered every 2 weeks for a total of 7 prolotherapy sessions. Following the series of prolotherapy injections, there was a marked closure observed in the diastasis, decreasing from 2.7 cm to 0.5 cm. The patient did not report any side effects, and no complications were observed or recorded. This appears to be the first case report documenting an improvement in abdominal diastasis recti following a course of prolotherapy. Within the limitations of the study design, further research is recommended to evaluate prolotherapy for diastasis recti in postpartum patients.

Plastie abdominale après grossesse gémellaire : à propos de 30 cas

Introduction Compared to single motherhood, the twin pregnancy results in important aesthetic and functional sequelae of the abdominal wall. The considerable uterine growth involves a musculocutaneous diastasis of both the supraumbilical and the infraumbilical area. This study presents the modified abdominoplasty technique with an inverted T scar as the appropriate treatment of supraumbilical and infraumbilical musculocutaneous defects. Methods and materials This series reviews a total of 30 female patients of 35 years on average. There was no cases obesity or smoking reported. Surgical treatment consisted in a skin and fat resection following an inverted T scar design and associated to a muscle plication. In 6 patients it has been necessary to repeat the procedure in 6 months time. Results All 30 patients resolved with an aesthetic and functional improvement. No instances of abdominal diastasis recidivation occurred. Ther were no complication observed and no impact on the healing process was referred. Conclusion on of the main differences between single and gemellary pregnancies is that the second ones are concerned by an abdominal diastasis marked on both a vertical and a transversal direction. The complete surgical treatment sometimes includes a second intervention. Clinical results and luck of complications suggest that the T-type abdominoplasty associated to a muscle retightening offers an appropriate surgical treatment of patients concerned.

Triangular mattress suture in abdominal diastasis to prevent epigastric bulging.

In the classic abdominoplasty, the treatment of large diastasis recti with simple or vertical mattress sutures may result in a nonaesthetic bulge. The surgeon may produce a craniocaudal bulge deformity by treating the flaccidity in the horizontal plane only, although it occurs in all directions. The authors describe the triangular mattress suture for the treatment of large diastasis recti, and demonstrate the mechanism involved in producing an epigastric bulge. Also presented is their clinical experience with 56 patients, with a 3-year follow-up, using this new plication method. The triangular mattress suture is a simple, quick, and effective way to correct abdominal diastasis and to avoid the epigastric bulge deformity with no added morbidity.