Abdominal Wall Research Articles

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal (TPP) approach is a new concept that was recently introduced. Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages, there is little evidence reflecting the characteristics and feasibility of either approach. AIM To analyze the potential applications of single-incision laparoscopic TPP (SIL-TPP) inguinal hernia hernioplasty for the treatment of inguinal hernias. METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022. A single-port, named Iconport, and standard laparoscopic instruments were used during the operation. Demographic data, intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed. RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1 . The average age was 49.5 years (range from 21 to 81 years). The average body mass index was 27.7 kg/m2 (range from 17.7 kg/m2 to 35.6 kg/m2). SIL-TPP were conducted successfully in 147 patients. Three patients were converted to the SIL-transabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience. In 2 patients with incisional hernias, an auxiliary operation hole was added during the SIL-TPP procedure, as required for surgery. The mean operative time was 64.5 minutes (range: 36.0-110.0 minutes) for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias (range: 40.0-150.0 minutes). The mean postoperative hospital stay was 3.4 days. CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair. SIL-TPP has potential benefits for patients with various abdominal wall hernias. Consequently, doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

Optimal Management of Traumatic Abdominal Wall Hernias Remains Unclear.

High-energy, blunt force trauma to the abdomen results in an abdominal wall injury (AWI) in up to 9% of patients. In 1% of blunt abdominal trauma, they result in a traumatic abdominal wall hernia (TAWH). Optimal management of these injuries remains unclear. Because they are the result of a high-energy mechanism, concomitant serious abdominal organ injuries are common. This has prompted some to advocate that the presence of a TAWH on physical exam mandates exploratory laparotomy. However, delayed repairs have better outcomes and nontherapeutic celiotomy should be avoided. Similarly debated is the expanding use of minimally invasive techniques and the use of mesh for hernia repairs. Overall, the presence of a TAWH is likely not an absolute indication for emergency surgery. Rather, it is an indicator of high-energy impact and associated with a high rate of visceral injury. These patients require a close observation for clinical decline and development of typical indicators for laparotomy.

Outcome of Fetuses with Anterior Abdominal Wall Defects in A Tertiary Referral Hospital

Outcome of Fetuses with Anterior Abdominal Wall Defects in A Tertiary Referral Hospital

Vascularization of Human Acellular Dermal Matrices: A Comparative Study in a Nonhuman Primate Model.

Four human acellular dermal matrices (hADMs) were characterized in a nonhuman primate abdominal wall repair model by evaluating host immune response, vascularization, and incorporation into host tissues. AlloDerm™ (electron beam-sterilized hADM [e-hADM]), AlloMax™ (gamma beam-sterilized hADM, freeze-dried [g-hADM-FD]), DermaMatrix™ (hADM, freeze-dried [hADM-FD]), and FlexHD™ (ethanol-treated hADM [EtOH-hADM]) were each implanted in an abdominal wall-bridging defect in nonhuman primates (n=3 animals/time point, N=36 animals). Immunohistochemical and histological assessments were conducted on biopsies from each hADM at 1, 3, and 6 months post-implantation to assess vascularization (hematoxylin and eosin [H&E], CD31, alpha smooth muscle actin [αSMA], collagen IV), inflammatory/immune response (H&E, CD3, CD20, CD68), and collagen turnover (H&E, matrix metalloproteinase-9 [MMP-9]). MMP-9 immunolabeling was similar among different hADMs at 1 month; however, hADM-FD and EtOH-hADM showed higher total mean MMP-9-immunopositive areas at approximately 16% compared with <1% for e-hADM and g-hADM at 6 months post-implantation. Cells that stained positively for CD68, CD3, and CD20 were generally higher for hADM-FD and EtOH-hADM compared with other hADMs. The mean CD31-immunopositive area, CD31 vessel density, CD31 vessel diameter, and collagen IV-immunopositive area increased over time. Among all the hADM types, e-hADM had the highest mean (±SD) CD31-immunopositive area at 1.54%±1.01%, vessel density at 7.86×10-5±3.96×10-5 vessels/µm2, and collagen IV-immunopositive area at 2.55%±0.73% 1 month post-implantation. The pattern of αSMA immunolabeling varied among the hADMs. Histology showed that overall inflammation was mild at 1 month. Overall fibroblast repopulation and collagen remodeling increased over time from 1 to 6 months post-implantation. Fibroblast infiltration was minimal to mild at 1 month, with e-hADM showing the highest mean (±SD) score at 2.00±0.00 compared with other hADMs. Only hADM-FD was not completely replaced by neotissue formation at 6 months post-implantation. All hADMs promoted vascularization, cell infiltration, and incorporation into host tissue, which were associated with acute inflammation and immune responses, within a 6-month period. A trend toward relatively enhanced early vascularization in e-hADM compared with other hADMs was observed. Immunogenic responses among the hADMs in the present study showed a slight distinction toward more quiescent terminally sterilized hADMs (e-hADM, g-hADM-FD) versus aseptically processed hADMs (EtOH-hADM, hADM-FD).

The effect of cesarean section on the dimensions and ratios of mons pubis

BackgroundPregnancy and labor can impact women’s body contours. After a cesarean section, some women may experience aesthetic issues such as the formation of a panniculus and a bulging mons pubis. This study aimed to investigate the impact of cesarean sections on the dimensions of the mons pubis and their ratios.MethodsThe study included 194 multiparous Caucasian women. Participants’ ages ranged from 18 to 40 years, and their BMI ranged from 18 to 30. They were divided into two BMI groups. Each group was further subdivided based on the mode of delivery into vaginal delivery (VD) and cesarean section (CS) groups. Manual measurements of the three dimensions of the mons pubis (monal height, monal width, and monal length) were conducted. Measurements were recorded in centimeters in the lithotomy position using iGaging 8-inch digital outside calipers. Monal height is the distance between the anterior surface of the symphysis pubis and the maximum height of the mons pubis (calculated by measuring the distance between the anterior wall of the vagina and the maximum height of the mons pubis minus the distance between the anterior wall of the vagina and the anterior surface of the symphysis pubis). Monal width is the maximum transverse distance between the merging borders of the mons pubis and the fat of the lower abdominal wall. Monal length is the maximum longitudinal distance between the merging upper border of the mons pubis and the fat of the lower abdominal wall and the upper end of the pudendal cleft.ResultsNo significant statistical difference was observed between the three dimensions of the mons pubis in vaginal delivery and cesarean section populations in the two groups. The changes in the ratios between the two groups’ different monal dimensions in the cesarean section population are minimal and do not follow a consistent pattern. There were no significant differences between the dimensions of single and repeated CS populations, with non-trendy changes in the different ratios in the repeated CS group.ConclusionEven when repeated, cesarean section minimally affects the dimensions and ratios of the mons pubis. However, more studies with standardized fascial and subcutaneous fat closure are needed.

Efficacy of Colchicine and Melatonin in the treatment of rat endometriosis model: an animal study

ObjectiveThis study investigates the therapeutic effects of colchicine and melatonin on endometriotic implants in an experimentally created endometriosis model in rats. Study DesignForty-four adult female Wistar albino rats weighing between 260 and 300 grams, 8 weeks old, were selected for the study. The unilateral uterine horn of rats with a bicornuate uterus was excised for 1cm, washed with sterile saline, incised longitudinally, and the endometrium was exposed. A 0.5*0.5cm endometrial tissue sample taken with a scalpel was implanted with suturing (4/0 Vicryl) to the abdominal wall. Forty-four rats were divided into four groups. Group 1 was randomized as the endometriosis group (control), Group 2 as endometriosis + colchicine treatment, Group 3 as endometriosis + melatonin treatment, and Group 4 as the endometriosis + melatonin + colchicine treatment group. The colchicine (Sigma Chemical Co., St Louis, Missouri) group was administered orally at a dose of 0.1mg/kg, and the Melatonin group orally at a dose of melatonin (20mg/kg per day). Treatment continued daily for 30 days. ResultsIn the post-treatment focal diameter measurements, the endometrial focal diameter in the colchicine and colchicine + melatonin group was significantly lower than the control group (p=0.026). Bcl-2 levels of the colchicine group were lower than the control group and the melatonin group (p=0.021). ConclusionColchicine and melatonin reduce adhesion to the peritoneal surface in ectopic endometrial cells. It also acts by increasing apoptosis and decreasing cell survival.

Analysis of aborted bariatric surgeries and potential opportunities.

Aborted bariatric surgeries are an undesirable experience for patients as they are subjected to potential physical harm and emotional distress. A thorough investigation of aborted bariatric surgeries has not been previously reported. This information may allow the discovery of opportunities to mitigate the risk of aborting some bariatric operations. Data from the Michigan Bariatric Surgery Collaborative, a statewide bariatric surgery registry, were used to identify all aborted primary bariatric operations from June 2006 through January 2023. The reasons for aborting surgery were divided into seven categories. Stepwise logistic regression was performed to identify independent predictors of aborted procedures for potentially modifiable factors. A total of 115,004 patients underwent bariatric surgery with 555 (0.48%) procedures aborted. Of those having an aborted operation the mean age was 52years and mean BMI was 49.8 with females accounting for 72%. Sleeve gastrectomy had the lowest aborted rate (0.38%) as compared to gastric bypass, adjustable gastric banding, and biliopancreatic diversion (p < 0.0001). The most common aborted surgery reason categories included adhesions and hernias, tumors and anatomic anomalies, and inadequate visualization due to either hepatomegaly or abdominal wall thickness. The most significant (p < 0.0001) independent predictors of aborted surgeries due to hepatomegaly or abdominal wall thickness were BMI ≥ 60 (OR 10.7), BMI 50 to 59 (OR 3.1) and diabetes mellitus (OR 2.7). Preoperative weight loss was a protective factor for aborting surgery due to hepatomegaly or abdominal wall thickness (OR 0.9; p < 0.0001). Aborted surgeries are uncommon and occur in approximately 1 in 200 primary bariatric operations with the lowest rate identified in sleeve gastrectomy. Nearly 20% of operations are aborted due to hepatomegaly or abdominal wall thickness and targeting patients with elevated BMIs and diabetes mellitus for preoperative weight loss might reduce the risk of these types of aborted procedures.

Initial treatment for surgery-naïve desmoid tumors by high intensity focused ultrasound

IntroductionDesmoid tumor (DT) is a rare proliferative disease occurring in connective tissues, characterized by high infiltration and recurrence rates. While surgery remains the primary treatment, its recurrence risk is high, and some extra-abdominal desmoid tumors are inoperable due to their locations. Despite attempts with radiotherapy and systemic therapy, the efficacy remains limited.MethodsWe used low-power cumulative high-intensity focused ultrasound (HIFU) therapy as an initial treatment for desmoid tumor patients either ineligible or unwilling for surgery. Low-power cumulative HIFU employs slower heat accumulation and diffusion, minimizing damage to surrounding tissues while enhancing efficacy.ResultsFifty-seven non-FAP desmoid tumor patients, previously untreated surgically, underwent low-power cumulative HIFU therapy. Among them, 35 had abdominal wall DT, 20 had extra-abdominal DT, and 2 had intra- abdominal DT, with an 85% median ablation ratio. Abdominal wall DT patients showed significantly better response rates (91.4% vs. 86%) and disease control rates (100% vs. 32%) than that of non-abdominal wall DT patients. Median event- free survival time was not reached after a median follow-up duration of 34 months.DiscussionWith its high response rate, durable efficacy, and mild adverse effects, our findings suggest that low-power cumulative HIFU presents a promising novel treatment for desmoid tumors, particularly abdominal wall DT patients.

Protocolized Gastrointestinal Fistula Management is Superior to Historic Data and National Averages: A Retrospective Review of an Enterocutaneous Fistula Registry.

Background: Enterocutaneous fistula (ECF) management remains a complex clinical problem. Prehabilitation (prehab) protocols are becoming more popular. The prehabilitation protocol used in this paper was adopted in 2017 at the University of Florida. The Fistula Registry at University of Florida has captured the efforts of the UFAIR (University of Florida Abdominal Wall Reconstruction and Intestinal Rehab) service. We analyzed if the prehabilitation program is successful in reducing deaths, length of stay, recurrence of fistula, and readmissions to the hospital in our database.Methods: Charts were queried for patients with ECF/EAF from the UFAIR database from January 1, 2017, until present day. Several factors were recorded including: cause of fistula, recurrence of fistula, wound infection, postoperative sepsis, hospital length of stay, postoperative ICU length of stay, postoperative length of stay, death, discharge disposition, and if taken back to surgery.Results: 31 patients underwent prehabilitation while 30 patients underwent standard nutritional therapy. No deaths were reported in the prehab group, compared to 7 deaths in the standard group (P = .006). The prehab population had an average hospital stay of 15.19 days while the standard group had an average stay of 21.16 days (P = .045). 2/31 in the prehab protocol had a recurrence of ECF while 10/30 in the standard protocol recurred (P = .01). Conclusions: Our study showed promising data for the effects of prehabilitation protocol for patients with ECF. The outcomes of those in the prehab protocol surpassed historical outcomes. Our patients had no deaths, shorter hospital stays, and lower rates of recurrence.

Diagnosis and management of prune belly syndrome in pediatric patients

Prune-Belly Syndrome has been defined as a rare urological congenital anomaly. Worldwide, a prevalence of 1 per 50,000 live births was described. Among the characteristics that identify this syndrome are the deficiency of the abdominal wall musculature, dilation of the urinary tract and bilateral cryptorchidism. Management requires great interdisciplinary knowledge and even urological surgery. The objective of this work was to identify the main methods of diagnosis and management of Prune Belly Syndrome in pediatric patients through a bibliographic review. The bibliographic review was carried out with articles published from 2017 to 2023 in high-impact journals, 25 articles were found, 8 had case reports and 17 were a theoretical source of information. In short, the key diagnosis is established by means of a prenatal ultrasound, with respect to management it can be conservative or surgical and multidisciplinary management with specialists is important.

The clinical consequences of burst abdomen after emergency midline laparotomy: a prospective, observational cohort study.

The emergency midline laparotomy is a commonly performed procedure with a burst abdomen being a critical surgical complication requiring further emergency surgery. This study aimed to investigate the clinical outcomes of patients with burst abdomen after emergency midline laparotomy. A single-center, prospective, observational cohort study of patients undergoing emergency midline laparotomy during a two-year period was done. Abdominal wall closure followed a standardized technique using monofilament, slowly absorbable suture in a continuous suturing technique with a suture-to-wound ratio of at least 4:1. Treatment of burst abdomen was surgical. Data, including intra-hospital postoperative complications, were collected and registered chronologically based on journal entries. The primary outcome was to describe postoperative complications, length of stay, and the overall morbidity based on the Comprehensive Complication Index (CCI), stratified between patients who did and did not suffer from a burst abdomen during admission. A total of 543 patients were included in the final cohort, including 24 patients with burst abdomen during admission. The incidence of burst abdomen after emergency midline laparotomy was 4.4%. Patients with a burst abdomen had a higher total amount of complications per patient (median of 3, IQR 1.3-5.8 vs. median of 1, IQR 0.0-3.0; p = 0.001) and a significantly higher CCI (median of 53.0, IQR 40.3-94.8 vs. median of 21.0, IQR 0.0-42.0; p = < 0.001). Patients with burst abdomen had an increased risk of postoperative complications during admission as well as a longer and more complicated admission with multiple non-surgical complications.

Comparison of postoperative chronic inguinal pain between the lichtenstein and laparoscopic techniques in the treatment of inguinal hernia: a systematic review and meta-analysis.

Currently, inguinal hernias are highly prevalent in the Brazilian population, accounting for 75% of all abdominal wall hernias. The recommended treatment to correct them is inguinal herniorrhaphy, which can be performed through open surgery, mainly using the Lichtenstein technique, or laparoscopically, primarily through Transabdominal Preperitoneal Repair (TAPP) or Total Extraperitoneal Repair (TEP) approaches. Like any surgery, these procedures have post-operative complications, with pain being the most common and debilitating. Currently, in European and Brazilian guidelines, the open Lichtenstein and endoscopic inguinal hernia techniques are recommended as best evidence-based options for repair of a primary unilateral hernia providing the surgeon is sufficiently experienced in the specific procedure. In that matter, the surgeon should make a choice based on assessment of the benefits and risks of performing each of them, and practice shared making decision with it patient. Therefore, the objective of this review was to assess the incidence of chronic postoperative pain by comparing the aforementioned surgical approaches to evaluate which procedure causes less disability to the patient. The search conducted untilMay 2024 was performed on Medline (PubMed), Cochrane (CENTRAL), and Lilacs databases. The selection was limited to randomized clinical trials, nonrandomized clinical trials and cohort studies comparing TAPP or TEP to LC, evaluating the incidence of chronic postoperative pain published between 2017 and 2023. Evidence certainty was assessed using the GRADE Pro tool, and bias risk was evaluated with the RoB 2.0 tooland ROBINS I tool. Thirteen studies were included. RESULTS: The meta-analysis showed a significant difference between the groups in both techniques, favoring the laparoscopic approach, which had a lower occurrence of postoperative inguinodynia with a relative risk of 0.49 (95% CI = 0.32, 0.75; I2 = 66% (P = 0.001); Z = 3.28 (P = 0.001) with low certainty of evidence. The presence of chronic postoperative pain was lower in laparoscopic TEP/TAPP techniques when compared to the open Lichtenstein technique, meaning that the former can bring more benefits to patients who requires inguinal herniorrhaphy. Nevertheless, further randomized clinical trials are needed to optimize the analysis, minimizing the bias.

Bone and Soft Tissue Sarcoma Epidemiology in Iranian Elderly Population; an Analysis of the Iranian National Registry for Cancer (2009-2014 Years)

Background: We aimed to investigate the patterns of incidence and prevalence of bone sarcoma (BS) and soft tissue sarcoma (STS), morphology as well as geographical distribution in the elderly in Iran. Methods: By the primary site of the tumor and the morphological types, whole cases of cancer were classified. Then, the WHO classification (2018) and the third revision of the standard International Classification of Diseases for Oncology (ICD-O-3) were used to assign a code to them. The estimated incidence rates were obtained as the frequency of the newly-diagnosed cases within one year divided by the calculated population of the mid-year Iranian residents as estimated by the Iranian Bureau of Statistics. The age-standardized incidence rates were also estimated for both bone and soft tissue sarcoma. Results: The annual crude incidence rates of sarcomas in males (0.80 per 100,000) were more than in females (0.55 per 100,000) in all years. The total combined crude incidence in 2014 years was obtained at 0.67 per 100,000 people. In terms of disease grade majority of the patients were of grade 3 (11.5 %). In terms of tumor location, the Lower extremity was 16.8%, the Visceral (including gastrointestinal &amp; uterus) 15.8%, the Thoracic 12.8%, and the Pelvic &amp; abdominal wall 9.7%. Conclusion: Even though such sarcoma is more prevalent in elderly men, its incidence was also observed in lower-aged female groups. In addition, the incidence rate of BS was lower in comparison with that of STS, and the patients often exhibited an unknown degree of sarcoma.

Mininvasive surgery in abdominal wall repair: lights and shadows

Mininvasive surgery in abdominal wall repair: lights and shadows

Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study

ObjectivesTo evaluate the risk of major congenital anomalies according to infection with or vaccination against covid-19 during the first trimester of pregnancy.DesignProspective Nordic registry based study.SettingSweden, Denmark, and Norway.Participants343 066...

Giant Bowen’s disease of anterior abdominal wall with invasive squamous cell carcinoma-A rare case report

A 65 years old male presented to the out-patient department of Dermatology with complaints of a large verruco-erosive lesion on left anterior abdominal wall for 15 years. A wedge incision biopsy was done which showed features of Bowen’s disease. The patient was referred to department of General Surgery where a complete excision was done. The final histopathology report confirmed the diagnosis of Bowen disease with a focus of invasive carcinoma component. This case report is unusual for its clinical presentation, duration and location of the lesion.

TEP or TAPP: who, when, and how?

Groin hernia repair is the most common procedure performed by general surgeons. The open mesh technique generally represents the main technique for an inguinal repair, but a different approach is often required. Laparoscopy was found to be the answer to minimizing the impact of the preperitoneal open techniques described by Nyhus and Stoppa. The introduction of the totally extraperitoneal hernia repair (TEP) and transabdominal preperitoneal repair (TAPP) in the early 1990s started a new chapter in groin hernia surgery. The minimally invasive techniques vs. open mesh, and then one against the other, soon became a hot topic among abdominal wall surgeons. With time, the number of procedures and indications increased and are still increasing. This review aims to provide an overview of the two main laparoscopic techniques for groin hernia repair, answering the following questions: Who should perform them? What is the learning curve required to minimize complications and optimize operative time? When is a minimally invasive approach indicated, and which one (both in elective and in emergency setting)? How are they performed? The standard techniques have been described in detail, and personal observations from an abdominal wall surgery referral center were added. The main reviews from the early 2000s up to date, which compared the techniques, were analyzed, and the results reported, confirming the comparable safety and efficacy of both these techniques.

The benefits of preoperative smoking cessation on abdominal wall reconstruction outcomes: An examination of abstinent versus never smokers

IntroductionActive smoking is related to wound and respiratory complications following abdominal wall reconstruction (AWR), but no AWR studies directly compare outcomes of abstinent-smokers (AS), fulfilling four-weeks of smoking cessation, to non-smokers (NS). MethodsProspectively maintained institutional database was queried for all AWR between 2012 and 2019. AS and NS were included. Primary outcomes were wound and respiratory complications; secondary outcome was recurrence. Standard statistical analyses were performed. ResultsEvaluation included 1088 patients, 305 AS and 783 NS. AS had a lower BMI (31.3 vs 32.7 ​kg/m2; P ​= ​0.004) but increased ASA Class III (51.5% vs 34.5 ​%, P ​= ​0.009), COPD (8.9% vs 4.0 ​%, P ​= ​0.001), comorbidities (6.3 vs 4.7, P < 0.001), and wound class (Class III/IV: 25.3% vs 15.8 ​%, P ​= ​0.003). AS had increased defect size (229 vs 209.1 ​cm2; P ​= ​0.023), use of component separation (CST) (52.5% vs 43.8 ​%; P ​= ​0.010) and hospital stay (6.6 vs 6.2 days, P ​= ​0.015). Postoperative wound, mesh, and pulmonary infection, respiratory failure, and recurrence were similar.On multivariable regression, wound class and complications predicted recurrence. BMI, panniculectomy and CST predicted wound complications. BMI, CST, and wound class predicted respiratory complications. ConclusionDespite greater patient and hernia complexity, smoking cessation appears to result in similar outcomes to never-smokers in this AWR population.

Adult-onset methylenetetrahydrofolate reductase C677T mutation and its repercussion: A case report

Methylenetetrahydrofolate reductase (MTHFR) is an enzyme that converts homocysteine into methionine by catalyzing the conversion of 5,10-methyltetrahydrofolate into 5methyltetrahydrofolate. Deep vein thrombosis, coronary artery disease, peripheral vascular thrombosis, and cerebrovascular thrombosis are attributed to homozygous MTHFR mutations. We describe here a case of a 42-year-old male, who presented to us with subdural hemorrhage following systemic thrombolysis for pulmonary embolism. He was found to have hyperhomocysteinemia as a result of homozygous MTHFR C677T mutation. He underwent left fronto-temporo-parietal decompressive craniectomy and hematoma evacuation with the placement of a free bone flap in the right anterior abdominal wall and placement of an IVC filter to prevent recurrent venous thromboembolism. He was started on Vitamin B12, pyridoxine, and folic acid supplementation and was discharged in a stable condition with a plan for cranioplasty at a later date.

The Effectiveness of Physical Therapy Interventions in Management of Diastasis Recti in Postpartum Females: A Narrative Review

Diastasis recti is a condition caused by increased intra-abdominal pressure which causes the linea alba to stretch resulting in a wider inter-rectus gap. It is most common after pregnancy but can also be caused by obesity or previous abdominal procedures. Research shows myofascial laxity affecting the entire front abdominal wall. Postpartum women have a doubling of the interrectus distance and pregnancy affects abdominal muscle strength with nulliparous women having a higher number of trunk flexors and rotators [1]. DRA is mostly treated conservatively. Patients referred to a physiotherapist receive training programmes that specifically target reducing IRD. Some studies recommend training with physiotherapist, while others let patients train on their own. Recommended frequency of training sessions varied from one to five sessions per week. The exercise interventions consist of the following: Core trainings, Breathing technique and Mindfulness teaching. This study aims to find out the effectiveness of different physical therapy interventions in the treatment of diastasis recti abdominis. The condition of diastasis recti abdominis has prevalence in postpartum females and it is important to address this for the welfare of women and required to explore the best physical therapy treatment available.