Repair Of Rectus Diastasis Research Articles

Do Absorbable Sutures Work for Rectus Diastasis Repair in Abdominoplasty Patients?

The standard treatment for rectus diastasis is rectus sheath plication during abdominoplasty. Lasting correction of diastasis is essential, but there is currently a debate as to whether absorbable or nonabsorbable rectus plication achieves a lower rate of recurrence. The goal of this study is to assess long-term patient outcomes and the recurrence of rectus diastasis after plication with long-lasting absorbable sutures. A retrospective study of abdominoplasties performed by the senior author between 2018 and 2022 was performed. Only female patients with >6 months of follow-up were included. Plication of the rectus muscles was performed with a combination of interrupted, buried, figure of eight #0 polydioxanone suture and running #0 Maxon (Covidien, Mansfield, MA). Outcomes were assessed by physical examination at postoperative visits. A retrospective chart review was used to obtain demographic and perioperative information. Seventy-one patients underwent abdominoplasty with an average follow-up of 21.1 months. The average age was 43 years, and the average BMI was 27 kg/m2. Correction of rectus diastasis was performed using absorbable sutures in all patients with no recurrence of diastasis in any patient (0% diastasis recurrence rate). Complications included delayed wound healing (11%), seroma (8.5%), hematoma (2.8%), and deep vein thrombosis/pulmonary embolism (2.8%). No patients needed reoperation. Abdominal wall plication using a double-layered, long-lasting absorbable suture closure is a safe, reliable, and effective method to address rectus diastasis during abdominoplasty. Our technique achieved no recurrence of diastasis in any patient and a low complication profile.

Robotic Repair: An Alternative Technique for Rectus Diastasis and Abdominal Bulge Following DIEP Flap Breast Reconstruction.

The Deep Inferior Epigastric Artery Perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Despite advances in perforator dissection, abdominal morbidity still occurs. Traditional rectus diastasis (RD), abdominal bulge, and hernia repair with open techniques are associated with higher complication rates and recurrence. We present a novel case series of robotic repair of symptomatic RD and/or abdominal bulge with concurrent hernia following DIEP flap surgery. A single-center, retrospective review was conducted on 10 patients who underwent bilateral DIEP flap breast reconstruction and subsequent robotic repair of RD and/or abdominal bulge and hernia. Pre-operative demographics and post-operative clinical outcomes were reviewed. RD up to 5 cm, abdominal bulge, and any concurrent ventral/umbilical hernias were repaired robotically via retrorectus plication and macroporus mesh reinforcement. The average age and BMI were 49 years (range 41-63) and 31 kg/m2 (range 26-44), respectively. The average number of perforators harvested per flap was 2.5 (range 1-4). Average RD and hernia size were 3.95 cm (range 2-5) and 5.8 cm2 (1-15), respectively. Eight patients stayed one night in the hospital, two went home the same day as the robotic repair. No patients converted to open technique and none experienced complications within 30 days. For the patients who experience donor site morbidity following DIEP flap breast reconstruction, minimally invasive robotic repair of RD and/or abdominal bulge with hernia can be performed with mesh reinforcement. This technique is effective with low complication rates and should be considered over open repair.

Correction of Rectus Abdominis Diastasis: A Prospective Comparative Study Between a New Suturable Polypropylene Mesh vs Polypropylene Standard Suture Plication.

Duramesh (Mesh Suture Inc., Chicago, IL) is a new suturing concept, combining the principles of mesh with the precision, flexibility, and versatility of a suture, suitable also for abdominal rectus diastasis (ARD) correction. This prospective research aimed to compare mesh with the standard polypropylene suture plication for rectus diastasis repair with regard to safety (infection, seroma, hematoma, surgical wound dehiscence, and fistula rates and hospital stay); effectiveness (ARD recurrence by ultrasound sonography, palpability of the muscular suture, surgical time, and postoperative pain evaluation); and satisfaction of the patients based on the BODY-Q, a patient-reported outcome measure. Sixty-five of the initial 70 patients who underwent rectus diastasis repair with a 6-month follow-up were randomly divided into 2 groups, comprising 33 patients treated with Duramesh and 32 patients treated with standard 0 polypropylene suture plication. Data regarding infection, seroma, hematoma, surgical wound dehiscence, and fistula rates; hospital stay; ARD recurrence; palpability of the muscular suture; surgical time; postoperative pain evaluation (measured by visual analog scale, or VAS); and the BODY-Q were analyzed by Prism 9 (GraphPad Software Inc., San Diego, CA). No significant differences were reported between the 2 groups with regard to infection, seroma, hematoma, surgical wound dehiscence, and fistula rates and hospital stay. The mesh decreased the time required to perform plication compared with standard polypropylene detached sutures. No statistically significant differences were found with respect to the VAS and BODY-Q data. Duramesh 0 application for rectus diastasis repair is safe and effective without compromising aesthetic improvement when compared with standard 0 polypropylene plication.

Body Contour in the Post-Bariatric Male Patient

Background: Obesity is currently considered a public health problem. Bariatric procedures have become an important part of obesity management and, consequently, the number of male patients seeking post-bariatric reconstructive procedures have increased. Therefore, the clinical approach and understanding of the body contour of this population have become more relevant. The goal of post-bariatric reconstruction is to enhance the male silhouette through removal of skin and adipose tissue excess, and abdominal rectus diastasis repair. Material and Methods: We conducted a retrospective study at the Plastic and Reconstructive Surgery Department of the National Medical Center “20 de Noviembre”. All male patients referred to our department to start a post-bariatric reconstruction protocol from January 2018 to December 2022 were included in this study. Results: In total, 15 patients who underwent corporal contouring procedures were included; median age was 49.2 years with minimum of 33 years, and a maximum of 57 years. Median Body mass index was 28.4 kg/m2 with minimum of 22 kg/m2 and maximum of 38 kg/m2 . All patients were treated 18 months after their bariatric surgery. All patients underwent an abdominoplasty as a body contouring procedure. 4 (26.7%) patients presented complications related to the surgery. Conclusion: We propose a comprehensive and systematic approach to massive weight loss for male patients, suggesting an abdominal marking based on the patient's clinical features and the expected results avoiding feminization of the abdominal body contour.

Standardization of the Extent and Timing of Rectus Diastasis Repair in Abdominoplasty Cases with TOF Neuromuscular Monitoring: A Clinical Study.

Despite the close focus on the anterior abdominal wall and the classification, maneuvers and materials related to the rectus abdominis and its fascia, there is no established standard concerning the extent of plication. The anterior abdominal wall is a musculoaponeurotic structure and a dynamic motor system with innervation and tonus. Therefore, the timing of the plication is as important as the suture technique and material, since the muscle relaxant will lose its effect in varying time periods. The aims of our study were to determine the change in the amount of plication between groups with and without muscle relaxants before plication and whether the amount of this change can be standardized using train-of-four (TOF) monitoring. In 2022 and 2023, 12 women aged between 25 and 48 years with a body mass index between 24 and 38 years were included in the study. Neuromuscular blockade was monitored by train-of-four (TOF) monitoring in all patients. Maximum plication areas at above-zero TOF value and zero TOF value were calculated and compared with each other. The reduction in the area of group 1, which represents the phase without muscle relaxant, and group 2, which represents the phase with neuromuscular blockade, were compared using the t-test. When assessed for above-zero TOF, the area between plication lines (a, a') was always smaller than the area between the plication lines (b, b') when the TOF value was zero. The t test comparison of group 1, which includes (a, a') values, and group 2, which includes (b, b') values, resulted in a value of p = 0.000. All cases, the plication value obtained with above-zero TOF value was lower than the plication value when the TOF value was zero. This difference was also confirmed statistically on a group basis. This suggests that neuromuscular measurements should be taken during the plication phase in the routine flow of surgery. Muscle relaxants are not routinely administered to patients undergoing abdominoplasty or rectus diastasis repair who are already under sufficient analgesia, unless there is a pressure alert on the anesthesia device. The surgeon cannot always determine the degree of muscle laxity accurately by palpation. TOF monitoring is a cost-effective quantitative method that can be easily and quickly performed, accurately determining the timing of muscle-fascia plication of the rectus abdominis. Through this approach, the anterior abdominal wall can be plicated with maximum tightness and maximum aesthetic gain can be obtained.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Do Absorbable Sutures Work for Rectus Diastasis Repair In Abdominoplasty Patients?

Do Absorbable Sutures Work for Rectus Diastasis Repair In Abdominoplasty Patients?

An Abdominoplasty Modification for Postpregnancy Abdomen with Rectus Diastasis and Midline Hernia: The Technique and Results.

After pregnancy, some women experience severe rectus diastasis (RD), with body control dysfunction, midline hernia, or other quality-of-life impairment. The purpose of this study was to describe the authors' experience using hydrodissection and epidural anesthesia for lateral plication modification of abdominoplasty to restore abdominal wall firmness. A total of 46 consecutive patients with RD after pregnancy were enrolled. The mean intraoperative inter-rectus distance was 4.6 cm. RD is not always the only structure that has been elongated. Firmness of the abdominal wall also depends on lateral fascia structures. This study reports the total plicated distance addressing the lateral laxity in the abdominal wall. In this series, total plication was 7.8 cm, and 16 patients had a midline hernia. No hernia recurrences occurred, and the rectus bellies were less than 5 mm apart from each other in all participants, verified with ultrasound after 2 years of follow-up. Patient perspective of care and surgical outcome were recorded. Health-related quality-of-life domains were significantly improved postoperatively. Lumbar back pain visual analogue scale score was 4.5 ± 2.3 preoperatively and 0.5 ± 0.9 postoperatively. The ability to perform sit-ups increased from zero to 11, suggesting better motor control. The total complication rate was 10.9%. Hydrodissection and epidural anesthesia for lateral plication modification offers a reliable and effective treatment method for RD repair with and without a small midline hernia with a low complication rate. Therapeutic, IV.

OC-129 A new surgical technique for repair of rectus diastasis and associated hernia: description and initial experience

Abstract Aim Rectus diastasis (RD) is a common pathology, usually associated with midline hernias. Preaponeurotic surgical repairs have been described with complications derived from extensive subcutaneous dissection or suprafascial mesh placement. Other techniques place preperitoneal mesh but midline plication is not performed, with aesthetic disadvantages. We describe a new technique for the correction of ventral hernias associated with RD with midline plication and preperitoneal mesh (MPPM) and report our initial experience. Material and Methods We reviewed patients with RD and associated hernia surgically treated using the MPPM technique at our hospital from June 2021 to July 2022. The minimum follow-up time was 6 months. Results Forteen patients with RD and associated hernia were surgically treated with MPPM technique, with an average age of 64.1 years (range 38–82 years), 71.4% male and 28.6% female. The mean BMI was 28.8 Kg/m2 (range 18.6–40.0 Kg/m2). Three women (21.3%) had a mean of 1,3 previous pregnancies (range 0–2 pregnancies). The most common types of associated hernia with RD were primary midline hernia (50%), incisional hernia (21.4%), and recurrent midline hernia (28.6%). Half of the RD (50%) were M1-3 and the other half M2-3 (50%) as well as W1 (50%) and W2 (50%). The mean diameter of associated hernia was 3,2 cm (range 1–6 cm). Hematoma was observed in one patient (7,1%) in the first 30 postoperative days. No reccurence was recorded in the follow-up time. Conclusions The MPPM technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with RD.

The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery.

Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.

P-096 ASSESSMENT OF THE FASCIA HEALING PROCESS AFTER SUTURE PLICATION OF RECTUS DIASTASIS – MEASURED WITH ULTRASOUND AT ONE, TWO, THREE AND FOUR MONTHS FOLLOWING SURGERY

Abstract Aim Surgical repair of postpartum rectus diastasis (RD) has proven to provide functional improvements. Several different repair techniques have been described. There is no consensus regarding postoperative management and rehabilitation regimes varies. The purpose of this observational prospective cohort study was to follow and to better understand the healing process of the reconstructed linea alba with the aim to optimize the postoperative rehabilitation. Material and method Forty-five patients with RD operated with a standardized plication using absorbable suture material were included consecutively. All participants underwent a standardized postoperative rehabilitation program and were followed with ultrasonography examinations of the healing abdominal wall midline at one, two, three and four months after surgery. Interpretation of the ultrasound findings were defined by a specialist radiologist. The diameter of the duplicate was measured until it was totally contracted. The linea alba was considered totally regenerated when the anterior and the posterior lining were observed parallel. Results Early results showed that the duplicate had shrunk and the linea alba was totally recreated in 82.2% at the four-month examination. Corresponding numbers for the three, two and one-month examinations were 15.6%, 0%, and 0%. A preoperative inter-recti distance exceeding five centimeters showed a tendency to prolong the healing process. Conclusion The fascia healing time following a standardized suture repair was completed within four months in 4/5 of this cohort of postpartum women undergoing a RD repair. The findings can contribute to design an optimized rehabilitation regime following RD repair.

Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates.

Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical modalities. Due to the quickly evolving nature of this field coupled with the multiple novel surgical modalities described recently, there is a need for an updated review of surgical techniques and a quantitative analysis of complications and recurrence rates. A systematic review of PUBMED and EMBASE databases was preformed to retrieve all clinical studies describing surgical management of RD. Pooled analyses were preformed to assess recurrence and complication rates after both open and laparoscopic RD repairs (after controlling for herniorrhaphy). A total of 56 papers were included in this review. In patients who underwent both an RD and a herniorrhaphy, there was no significant difference in recurrence rates between open (0.86%) and laparoscopic repairs (1.6%) (p > 0.05). Similarly, in patients who underwent RD repair without a herniorrhaphy, there was no significant difference in recurrence rates between open (0.89%) and laparoscopic repairs (0%) (p > 0.05). The most common complications reported were seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. After controlling for a herniorrhaphy, there were no significant difference in total complication rates between open and laparoscopic RD repair. The total complication rates in patients who underwent an open RD repair with a herniorrhaphy were 13.3% compared to 14.5% in patients who underwent laparoscopic repairs (p > 0.05). Similarly, the total complication rates in patients who underwent RD repair without a herniorrhaphy were 11.8% in patients who underwent open repairs compared to 16.2% in their counterparts who underwent laparoscopic repairs (p > 0.05). Both open and laparoscopic approaches are safe and effective in repairing RD in patients with and without concurrent herniorrhaphy. Future research should report patient reported outcomes to better differentiate between different surgical approaches.

European Hernia Society guidelines on management of rectus diastasis.

The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested.

Mesh Repair of Rectus Diastasis for Abdominoplasty is Safer than Suture Plication.

Background:Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication.Methods:Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last set of office photographs.Results:Surgical site occurrence rate was 0% of the 40 patients in the mesh group and 19% of the 37 patients in the standard group (P = 0.005); rates of soft-tissue revision were 23% in the mesh group and 27% in the standard group (P = 0.84). As to aesthetics, the mesh abdominoplasty patients had mean statistically lower preoperative scores in comparison with the standard plication group (65.8 ± 11.6 versus 70.3 ± 11.4, P = 0.0013). The mesh group had a statistical improvement to 75.9 ± 12.6 (P < 0.0001), whereas the standard plication group improved to 82.5 ± 11.4 (P < 0.0001).Conclusions:Retrorectus mesh placement in a cohort of patients with severe rectus diastasis had a complication rate lower than that seen in a cohort of patients with less severe rectus diastasis, therefore negating our original hypothesis. This was done without compromising aesthetic improvement.

Mesh abdominoplasty for rectus diastasis in women and men

PurposeMeshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba.MethodsInclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates.ResultsSSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men.ConclusionRepair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis.

Impact of Rectus Diastasis Repair on Abdominal Strength and Function: A Systematic Review.

Rectus diastasis plication performed during abdominoplasty aims to narrow the widened linea alba and return the rectus muscle bellies to their anatomic position. It is unclear whether plication improves abdominal strength and function.This systematic review summarizes the effect of rectus plication on abdominal strength, function, and postoperative complications.A comprehensive search of CINAHL, Embase, Medline and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically.A total of 497 patients from seven articles were included. Mean age was 44.5 years (range 20.5-72) and 94.4% were female. Three articles reported abdominal strength measurements, with two showing significant improvement. Four articles used the SF-36 survey, all demonstrating improvement in physical function subscale postoperatively. An additional six instruments were used to assess functional outcomes, of which four demonstrated significant improvement. The overall complication rate was 17.0%.Rectus plication is commonly performed during abdominoplasty to improve abdominal form and function. While the literature to date is encouraging with respect to functional outcomes, improvements in abdominal strength are less consistent. Heterogeneity in patient population, outcome measures, and comparison groups limit the strength of our conclusions. Future research should include a large comparative study as well as a protocol for standardizing outcomes in this population.

A Comprehensive, Evidence-Based Literature Review of the Surgical Treatment of Rectus Diastasis.

Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy. Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability. Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.

Long-term follow-up after surgical repair of abdominal rectus diastasis: A Prospective Randomized Study.

Background:Abdominal rectus diastasis can lead to functional disability. There is no consensus regarding treatment. This was a prospective study on patients randomized to surgery using either Quill self-retaining sutures or retromuscular mesh for abdominal rectus diastasis repair. The primary aim of the study was to compare long-term recurrence after surgery. Secondary aims were abdominal muscle strength, pain, and quality of life.Methods:A total of 57 patients were eligible and 52 were investigated. A routine 1-year follow-up ruled out any patient with recurrence and this was followed up by clinical examination for recurrence and assessment of the secondary outcomes a median of 5 years (3.8–6.5 years) after surgery. Quality of life was assessed using the Short Form-36 questionnaire. Pain related to activity was evaluated using the Ventral Hernia Pain Questionnaire.Results:No recurrence of abdominal rectus diastasis was found. Significant improvements were seen between index surgery and long-term follow-up in all domains of Short Form-36. There were no significant differences in quality of life or self-reported muscle strength between the two surgical groups. Long-term pain remained unchanged compared to that at the 1-year follow-up. “Pain this week” had decreased significantly at long-term follow-up compared to prior to surgery (mesh p = 0.009, Quill p = 0.003).Conclusions:No recurrence of abdominal rectus diastasis appeared. There was no difference in quality of life or long-term pain between the two surgical groups. Implantation of retromuscular mesh entails more extensive surgery implying potentially higher risk for complications. This leads us to recommend reconstruction with double-row self-retaining sutures for the repair of abdominal rectus diastasis in patients with functional disability.

Double-mesh technique abdominal wall reconstruction for severe rectus diastasis and ventral hernia repairs (two for two)

Introduction Standard rectus plication techniques may not suffice for severe cases of rectus diastasis, especially with ventral hernia. In our study, prosthetic subfascial sublay mesh and onlay mesh may facilitate the repair of severe rectus diastases, especially with concomitant ventral hernias. There is little agreement about the most appropriate technique to repair these defects, in spite of the fact in the prevalence of ventral hernias we are often faced with reinforcement with prosthetic meshes. In the component separation technique, we found high unaccepted recurrence rate. In an attempt to reduce recurrences, we attempt to use sublay mesh and onlay mesh to inforce the defect and prevent or to decrease the recurrence. Our objective was to determine prosthetic mesh practice patterns of onlay and sublay reconstructive methods regarding indications. Patients and methods A total of 32 consecutive patients who underwent abdominal wall reconstruction by means of component separations associated with polypropylene mesh were included. A technique of placing mesh in a sublay manner, deep to the rectus muscles without anterior dissection of rectus abdominis from anterior sheath to avoid damage of its blood supply and damage deep umbilical perforators during dissection ended by onlay mesh on anterior rectus sheath, was applied. The complications were recorded and follow-up data were obtained after double-mesh technique. Aim To use prosthetic polypropylene mesh sublay (above or anterior to the posterior rectus sheath) with another onlay mesh (above the anterior rectus sheath) for rectus diastasis with or without ventral hernia. Results From May 2016 to January 2018, we had 16 patients who underwent cosmetic abdominal repair either for a ventral hernia repair with mesh or a rectus diastasis repair with mesh. Three patients had (isolated) rectus diastasis alone. The mean age of the patients was 55 years, with a range of 35–75 years of age. Overall, 92% of the patients were female. The mean;Deg;BM;Deg;I of the patients was 32 kg/m2 (range: 25–40 kg/m2). There were no surgical-site infections but three surgical-site occurrences − seromas, which were treated with drainage in the office. After an average of 365 days of follow-up, none of the patients had recurrence of a bulge or a hernia. Conclusion This study used a double-mesh reinforcement procedure, with a low rate of recurrence and occurrences. Moreover, the repair of a large, complex hernia by double-mesh repair technique augmented with polypropylene onlay mesh and sublay results in lower recurrence rates compared with historical reports of component separation technique alone.

Case series of a novel open plication supported by mesh (PSUM) - technique for symptomatic abdominal rectus diastasis repair with or without concomitant midline hernia: Early results and a review of the literature

BACKGROUND: Abdominal rectus diastasis (ARD), sometimes combined with abdominal wall midline hernia, is a common complaint in women after childbirth. To some individuals, ARD causes functional disability. Convincing data of the long-term results of ARD repair are lacking, especially when ARD is severe, and the optimal technique is undefined. In plastic surgery, the repair is often done with suture alone, but if a concomitant hernia exists, using a mesh is mandatory. This paper reports a novel surgical technique aimed at a reliable and minimally traumatic repair of ARD with or without midline hernia and a review of the literature of ARD repair. PATIENTS AND METHODS: During June 2013–April 2018, 37 consecutive patients with symptomatic ARD with or without concomitant midline hernia were operated on by using a narrow piece of a self-gripping mesh (n = 32) or the tails of the ventral patch (n = 5). The mesh was placed in between the plicated linea alba. The outcome and patient satisfaction in this pilot study were analyzed. RESULTS: A significant subjective improvement in body balance after surgery was reported by 34 patients (92%). During the mean follow-up of 13 months, there was only one partial recurrence of ARD. The complication rate was low, and patient satisfaction was good. CONCLUSION: According to the present study, selected patients with severe lack of muscle control and/or back pain benefit from ARD repair. The minimally traumatic PSUM mesh augmentation seems a promising method for the repair of ARD.

Abdominoplasty with Scarpa's Fascia Advancement Flap to Enhance the Waistline.

Abdominoplasty for body contouring has evolved from focusing primarily on modification of the skin flap and underlying rectus diastasis repair, to the association of liposuction and limited undermining techniques. While plication of the midline diastasis reliably improves anterior posterior dimensions, it has a more limited effect on the waist contour. Nahas suggested that increasing the width of the plication of the anterior rectus sheath may be responsible for displacement of the contours of the abdomen, yielding unnatural results.1 In an attempt to achieve reliable waist modification, different techniques have been published. L-shaped external oblique muscle plication, multidirectional abdominal wall plication, and advancement of the external oblique muscle flaps have been described.2 Plication of the external obliques demonstrates limited mobility and the creation of widely undermined external oblique flaps is typically beyond the scope of the standard outpatient procedure. It has been suggested that the preservation of Scarpa's fascia during abdominoplasty may lead to a decrease in postoperative complications.3,4 Friedman et al suggested that up to 17% of the lymphatic drainage of the abdominal wall is maintained if dissection is performed above Scarpa's fascia.5 The use of Scarpa's fascia to enhance the waist line definition during abdominoplasty has been limited. Mossaad et al used a medial directional pull on Scarpa's fascia in an effort to define the waistline as a modification of the lipoabdominoplasty technique described by Saldanha et al.6-9 Mossaad's technique removes a full thickness midline strip of subcutaneous tissue below the umbilicus down to the rectus sheath, extending approximately 4 cm lateral to the midline on each side. Tissue advancement was achieved only through lipo-mobilization using standard liposuction techniques with o undermining above the umbilicus other than the midline. Mallucci presented a refinement to traditional abdominoplasty using a superficial fascial …