Diastasis Recti Research Articles

Diastasis recti is associated with incisional hernia after midline abdominal surgery.

Incisional hernia occurs in up to 20% of patients after abdominal surgery and is most common after vertical midline incisions. Diastasis recti may contribute to incisional hernia but has not been explored as a risk factor or included in hernia risk models. We examined the association between diastasis recti and incisional hernia after midline incisions. In this single-center study, all patients undergoing elective gastrointestinal surgery with a midline open incision or extraction site in a prospective surgical quality collaborative database between 2016 and 2020 were included. Eligible patients had axial imaging within 6months prior to surgery and no less than 6months after surgery to determine the presence of diastasis recti and incisional hernia, respectively. Radiographic hernia-free survival was assessed with log-rank tests and multivariable Cox regression, comparing patients with and without diastasis width > 25mm. Of 156 patients, forty-four (28.2%) developed radiographic hernia > 1cm. 36 of 85 patients (42.4%) with DR width > 25mm developed IH, compared to 9 of 71 (12.7%) without DR (p < 0.001). Hernia-free survival differed by DR width on bivariate and multivariable Cox regression, adjusted hazard ratio: 3.87, 95% confidence interval: 1.84-8.14. Diastasis recti is a significant risk factor for incisional hernia after midline abdominal surgery. When present, surgeons can include these data when discussing surgical risks and should consider a lower risk, off-midline approach when feasible. Incorporating diastasis into larger studies may improve comprehensive models of incisional hernia risk.

A bibliometric and visualized research on global trends of abdominoplasty, 2011-2021.

Patients with multiple pregnancies, multiple pregnancies, and a history of severe obesity, the abdominal wall muscles, and skin exhibit rectus abdominis separation and skin laxity due to prolonged overstretching, which causes damage to both the patient's appearance and health. Abdominoplasty is a surgical solution to the problems of separation of the rectus abdominis muscle and laxity of the skin of the abdominal wall under direct vision, which is important for patients with the above problems. Currently, many studies have been reported on abdominoplasty, however, no reverent bibliometric analyses of abdominoplasty have been published. In this study, we screened 1,119 studies on abdominoplasty between 2011 and 2021 based on the Web of Science Core Collection (WOSCC) database and performed a bibliometric analysis. We found that high-quality research related to abdominoplasty has increased in the last decade, and the United States was the leading country in the field of abdominoplasty. Stanford university ranked first in number of publications and citations. Aesthetic surgery journal was the most productive journal, followed by the Plastic and reconstructive surgery and Aesthetic plastic surgery. In addition, bariatric surgery, venous thromboembolism, rectus diastasis, breast reconstruction and umbilicoplasty are the keywords of recent publications that are the focus of current research. This study provides a comprehensive analysis and visualization of global research trends on abdominoplasty from 2011 to 2021, and improvements in abdominoplasty to reduce the incidence of postoperative complications will remain a focus of future research.

Post-partum abdominal wall insufficiency syndrome (PPAWIS): lessons learned from a single surgeon’s experience based on 200 cases

BackgroundPost-partum abdominal wall insufficiency (PPAWI) with rectus diastasis is present in over 30% of women after pregnancy. Little is known about how PPAWI affects the social, sexual life and self-esteem of patients. This study was designed to evaluate the safety of onlay mesh combined with abdominoplasty and its impact on the well-being of the patients.MethodTwo hundred patients with PPAWI underwent surgery with onlay mesh and abdominoplasty. The safety of the procedure was assessed by postoperative complications, time of hospitalization and time of drainage. Before the operation and 6 months later, a questionnaire asking about the patient’s sexual and social life and the presence of back pain was completed. The final cosmetic effect was assessed separately.ResultsThe onlay procedure with abdominoplasty was found to be safe and fast. The mean operation time was 82 min, and the drainage time was 2.1 days. In this group < 2% postoperative complications were noted. There were no recurrences within the 6 month. Significant improvements in social and sexual life and the level of self-esteem were noted. Back pain was relieved or minimalized in all patients. The final cosmetic effect was insufficient for 2 patients (1%).ConclusionPPAWI can be treated safely with onlay mesh and abdominoplasty. The patients’ symptoms were strongly correlated with the morphological status of the front abdominal wall and improved after the procedure. Describing the psychological and social consequences of PPAWI should lead the surgical societies to propose a definition of a new disease called PPAWIS (post-partum abdominal wall insufficiency syndrome).

Predictors of Disability Attributed to Symptoms of Increased Interrecti Distance in Pregnant and Postpartum Women with Diastasis Rectus Abdominis

Background: Physically and physiologically, pregnancy and parturition are the phases of transformation for women. During pregnancy, the rectus abdominis muscles move laterally, and the interrecti distance increases and may remain increased in the immediate post-birth period which can lead to disability. Objective: To investigate various physical and physiological factors that can cause disability attributed to symptoms of increased interrecti distance after childbirth. Methods: This cross-sectional survey was conducted from after approval from the ethical committee. About 239 postpartum females with age ranges of 25 to 35 years having an interrecti distance of at least 2 cm and whose youngest child ages between 1 to 8 years were included. Correlation analysis was applied for different variables using Pearson correlation with a disability as the outcome variable and fear-avoidance beliefs, emotional distress, body mass index, lumbopelvic pain, increased interrecti distance, and physical activity level as predictor variables. Results: Four strong predictors were considered that cause disability in the postpartum females with almost 2 finger-width increased interrecti distance at baseline. All patients reported disability caused by symptoms produced by these strong independent predictors like body mass index, fear-avoidance, depression/anxiety, and lumbopelvic pain. The disability was caused by symptoms of body mass index of 22%, with Tampa scale of kinesiophobia questionnaire fear-avoidance belief cause disability 23.4%, with hospital anxiety and depression score was 10%, and with lumbopelvic pain 16% or mean value of visual analog scale 5.78% and total score of pain disability index was reported 9%. The p-value for correlation of all predictor variables with disability outcome variable shows a significant correlation between them. Conclusion: The intensity of lumbopelvic pain, fear-avoidance attitudes, body mass index, and emotional distress are the primary causes of disability related to symptoms of an increased interrecti distance after childbirth. These four predictor variables show a significant correlation with disability.

DIASTASIS RECTI ABDOMINIS: PROBLEMS OF DIAGNOSIS AND TREATMENT OF FALSE HERNIA

Diastasis recti abdominis (DRA) is a pathological state characterized by thinning and stretching of the aponeurotic plate of the white line. In the neglected cases, the entire muscular-aponeurotic skeleton of the anterior abdominal wall, up to the Spigelian line, sticks out and bulges. DRA is an urgent problem of modern surgery. Its management and treatment takes much time and effort.&#x0D; The literature review analyzes the main causes and risk factors of DRA, and describes its pathogenesis in detail. Particular attention is paid to diagnostic methods. A number of classifications are considered depending on diastasis etiology, localization and degree. It is shown that diastasis diagnosis is based on a thorough history, patient’s complaints, and clinical examinations. Ultrasonography, computed tomography, and magnetic resonance imaging should be performed when a concomitant umbilical or epigastric hernia or other reason for the patient’s symptoms cannot be ruled out. The authors describe practical methods for DRA surgical management. They evaluate the efficacy of various treatment modalities and the results of treating patients with DRA. It is noted that optimal surgical management for DRA correction has not been found yet. However, there is no treatment modality, which suggests an operation without general anesthesia. Any surgical intervention for DRA management implies the use of combined endotracheal anesthesia. Choosing a surgery for DRA management, the surgeon should take into account the patient’s opinion on the method of surgical assistance, minimize the period of hospital treatment if possible, use reliable techniques, ensure a patient’s quick recovery with a maximum cosmetic effect and minimum complications.

A Novel Modification of Subcutaneous Onlay Endoscopic Repair of Midline Ventral Hernias With Diastasis Recti: An Indian Experience.

IntroductionA ventral hernia is a common problem in the population. Many patients with umbilical/epigastric hernia often present with diastasis recti (DR) too. Diastasis recti is the thinning of the linea alba with an abnormal increase in the distance between the recti without a concomitant fascial defect. The presence of diastasis recti complicates the repair of the existing umbilical/epigastric hernia. Repair of only the umbilical/epigastric hernia in the presence of DR results in incomplete repair and predisposes to recurrence. There are various options available for the repair of umbilical hernia with diastasis recti. Open hernia repairs often have unsatisfactory cosmetic outcomes and, furthermore, involve complications frequently associated with large incisions such as surgical site occurrences (SSO), pain, dermal flap necrosis, and delayed postoperative recovery, to name a few. The era of minimal access surgery leaves us with a vast array of creative solutions to the same. Laparoscopic onlay repair has been given various names in literature, e.g., minimally invasive linea alba reconstruction (MILAR), pre-aponeurotic endoscopic repair (REPA), endoscopic linea alba reconstruction (ELAR), subcutaneous onlay laparoscopic approach (SCOLA), and totally endoscopic assisted linea alba reconstruction (TESLAR), with similar principles for all the procedures. The average rate of seroma formation in these procedures varies from 5% to 40%. SCOLA has been used in our study, with an added modification of the operating port and limiting the extent of lateral dissection with the aid of spinal needles, resulting in restrained dissection and creation of smaller lipocutaneous flaps, leading to reduced incidence of seroma formation.MethodsPatients with symptomatic primary ventral hernia with concomitant diastasis recti were enrolled in the participating center from the period of May 2020 to December 2021. Thirty patients were enrolled for this prospective study. The patients underwent subcutaneous laparoscopic onlay repair of midline ventral hernia with diastasis recti, with plication of the defect and onlay placement of a polypropylene mesh.ResultsSix point sixty-six percent (6.66%) of the patients developed seroma and SSO. The incidence is congruent with the results available in current literature. None of the patients had necrosis of umbilical skin. There were no recurrences at the three months follow-up.ConclusionOur modification of SCOLA is an ergonomically favorable procedure and has comparable outcomes to other approaches, with minimal complications.

Association of Pelvic Floor Distress with Pelvic Floor Function, Diastasis Recti and Core Strength In Primiparous Women Postpartum 6 Weeks: A Cross-Sectional Study

Introduction: Pelvic floor plays an important role in maintaining continence. Pelvic floor distress reduces muscle strength, evaluation of pelvic floor muscle function is important. Methods: Microsoft-Excel 2016 was used for data entry and basic Descriptive Statistics. Based on normality of the data as p value is less than 0.05, Spearman’s correlation coefficient test was used. Results: There was fair significant association found between pelvic floor distress &amp; diastasis recti below level of umbilicus. Conclusion: The results of the current study reject alternate hypothesis and states that fairly significantly correlates with diastasis recti below level of umbilicus pelvic floor distress is not correlated with pelvic floor function, diastasis recti above umbilicus, core strength. KEYWORDS: Pelvic floor, distress, muscle strength.

The Hernia Coding Conundrum: A Potential Benefit of the International Hernia Collaboration Online Social Media Platform.

Despite various resources on the subject, there remain questions regarding billing and coding hernia surgery. Recently, social media has been used to disseminate information in about surgery. The purpose of this project is to evaluate posts relating to coding through one online social media platform. The International Hernia Collaboration Facebook site was queried with terms relating to coding. Inclusion criteria were post discussing coding on the site. Posts relating to coding were reviewed by at least 2 reviewers. Number of comments, main topic of question, and additional information about codes were recorded and descriptive statistics generated. There were 100 posts found using the search term coding of which 85 met inclusion criteria. Post ranged from 5/2014 to 6/2021. Posts were from 72 surgeons with an average of 12 responses per post. Posts most commonly related to ventral and incisional hernia (53) followed by inguinal (18), other (19), diaphragm (4), and inguinal/ventral (1). For the ventral/incisional hernia, the most common posts were related to myofascial release techniques (29) followed by mesh (6), botox (5), hernia prevention (3), other (3), robotic surgery (2), open surgery (2), rectus diastasis (2), and laparoscopy (2). There remains controversies over coding for hernia repair particularly myofascial releases in ventral and incisional and new techniques using the robot. An online social media platform appears to be a viable way to disseminate coding information and generate discussion. Further study is needed to evaluate the role of social media for coding.

The Association between Postpartum Pelvic Girdle Pain and Pelvic Floor Muscle Function, Diastasis Recti and Psychological Factors-A Matched Case-Control Study.

There is uncertainty regarding the association between abdominal morphology, pelvic floor function, and psychological factors in women with postpartum pelvic girdle pain (PGP). The aim of this case-control study was to evaluate the differences between women with and without persistent PGP regarding pelvic floor function, diastasis recti, and psychological factors 6–24 weeks postpartum. Pelvic floor manometry, palpation examination of abdominal muscles, the International Consultation on Incontinence Questionnaire Short Form, The Depression, Anxiety and Stress Scale—21, and the Pain Catastrophizing Scale were used. The PGP group presented with lower vaginal resting pressure (p < 0.001), more tenderness (p = 0.018) and impaired voluntary activation of pelvic floor muscles (p ≤ 0.001). Women with pain also had more distortion on the level of the anterior abdominal wall (p = 0.001) and more severe diastasis recti (p = 0.046) when compared to pain-free controls. Lower vaginal resting pressure was the strongest factor explaining PGP (OR 0.702, 95%CI 0.502–0.981). There were no differences in terms of the pelvic floor strength, endurance, severity of urinary incontinence and reported distress between the groups. Women with PGP 6–24 weeks postpartum differ in pelvic floor and abdominal muscle function from the pain-free controls. Vaginal resting pressure may be an important factor in pelvic girdle pain shortly postpartum. Further studies are needed to see a trend in changes over time.

Mastopexy and Abdominal Skin Excision with Liposuction.

INTRODUCTION Body contouring procedures are performed to treat excess skin following weight loss and have been associated with increased quality of life and improved body image.1 Mastopexy is indicated to treat breast ptosis and remains one of the most commonly performed plastic surgery operations in the United States.2 A number of skin excision patterns including the circumareolar, vertical, L-shaped, short-scar periareolar, and Wise-pattern have been described, with technique selection dependent on the degree of breast ptosis and amount and location of skin excess.3 Similar to a reduction mammoplasty, the nipple-areolar complex may be based on either a superomedial, medial, superior, inferior, lateral, or central pedicle.3 To treat abdominal skin excess, interventions ranging from a conservative excision of skin and fat to a traditional or fleur-de-lis abdominoplasty with fascial plication and umbilical transposition may be utilized depending on the degree and location of excess skin and fat as well as the presence of rectus diastasis.4 Finally, liposuction may be utilized with excisional treatment of abdominal skin excess to add improved contouring.5 Here, we present the case of a young woman who desired treatment of breast ptosis and excess abdominal skin and fat following weight loss. CASE REPORT A 19-year-old woman presented following approximately 50 pounds of weight loss with diet and exercise. She had been weight stable for over 1 year. She was noted to have bilateral grade II breast ptosis and a moderate amount of excess infraumbilical skin and fat with no hernias or rectus diastasis. She was deemed to be an excellent candidate for bilateral wise-pattern mastopexy with a superomedial pedicle and an excision of excess infraumbilical skin and fat, with additional liposuction of her axilla, abdomen, and flanks. Consent for the use of video and photograph images was obtained from the patient. Markings The patient was marked in a standing position (Video). (See Video [online], which demonstrates operative technique for bilateral mastopexy, abdominal skin and fat resection, and liposuction.) The sternal notch to nipple distance was 22 cm. The inferior border of the areola to inframammary fold (IMF) distance was 6 cm, and the width of the pedicle at its base was 8 cm. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"The video demonstrates operative technique for bilateral mastopexy, abdominal skin and fat resection, and liposuction.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_am59bf2h"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Surgical Technique The details of the operation are shown in the Video. Tumescent solution (1 L in total) was infiltrated before completion of the mastopexy, followed by liposuction, and finally, by abdominal skin and fat resection. DISCUSSION A Wise-pattern skin excision was chosen for the mastopexy, given the significant amount of vertical excess skin as well as ptosis. A more conservative skin resection pattern (eg, vertical) may have obviated the need for an IMF scar. A limited abdominal skin excision rather than an abdominoplasty with umbilical transposition was chosen to minimize dissection and potential complications (ie, umbilical necrosis, seroma from extensive undermining, etc). An abdominoplasty with umbilical transposition may have allowed for improved final umbilical positioning. CONCLUSIONS The patient was noted to be healing well at her 3 week postoperative visit and was very satisfied with her aesthetic outcome. Mastopexy may be safely performed in combination with abdominal skin resection and liposuction for such patients, avoiding a traditional abdominoplasty in young populations.

Rehabilitation programme including EMG-biofeedback- assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial

ObjectiveTo evaluate the effect of a comprehensive rehabilitation programme on closure of the rectus diastasis (RD) and quality of life in women after delivery. DesignA randomised controlled trial with blinded assessment. SettingA tertiary hospital and participants’ homes in Foshan, China. SubjectsSixty-six women with RD 2–6 months after delivery were recruited into this study (study group n = 33, control group n = 33). The mean age of participants was 29.9 [standard deviation (SD) 4.3] years. InterventionsEach participant performed abdominal exercises. Patients in the study group received electromyographic-biofeedback-assisted pelvic floor muscle training (BAPFMT) in combination with neuromuscular electrical stimulation (NMES) of the rectus abdominis, and patients in the control group underwent NMES of the rectus abdominis alone. Main outcomesThe main study outcomes were inter-recti distance (IRD) and change in Short-Form Health Survey-36 (SF-36) scores 6 weeks after the intervention. ResultsA significant decrease in IRD was observed in the study group at 6 weeks [study group 1.6 (SD 0.3) cm vs control group 2.0 (SD 0.3); mean difference − 0.4, 95% confidence interval (CI) − 0.59 to − 0.26]. Similarly, the physical component summary, an integral component of SF-36, showed a significant improvement in the study group compared with the control group at 6 weeks [study group 45.5 (SD 1.2) vs control group 41.2 (SD 2.6); mean difference 4.3, 95% CI 3.72–4.50]. ConclusionA postpartum programme including BAPFMT for women with RD is feasible and improves the physical domain of quality of life. Clinical trial registrationClinicalTrials.fimmu, No: RCT 02561078. Contribution of the paper•A postpartum programme including BAPFMT appears to reduce IRD.

Pelatihan Mengenalkan Diastasis Rektus Abdominis pada Tenaga Kesehatan di Desa Talang Jawa UPTD Puskesmas Tanjung Agung

Physiologically in pregnant women there will be changes in the abdominal wall, in which the abdominal wall muscles will stretch/an increase in abdominal distension as a result of increasing uterine volume which has an impact on decreasing abdominal muscle tone. The abdominal wall muscles stretch and eventually lose some muscle tone. During the third trimester, the rectus abdominis can separate, causing the abdominal contents to protrude toward the midline of the body, this separation is known as diastasis recti abdominis. Based on the author's survey of 10 midwives in obtained, the level of knowledge of the midwives about diastasis rectus Abdominis (DRA), sufficient level of knowledge was 40% and less than 60%, of the midwife was didn,t know how to conduct a DRA examination on postpartum mothers. The purpose of this activity is to increase the knowledge and skills of participants how to do check DRA And evaluate result of competence of the midwife in providing services to postpartum women in their clinic already applies Diastasis Recti Abdominis examination to every patient. Conclusion: There was an increase of knowledge participants before and after training. There was an increase in the ability of participants to perform an examination of Diastasis Rectus Abdominis on postpartum mothers, both before and after the training

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.

Double mesh repair in management of abdominal wall reconstruction for rectus diastasis and or ventral hernia repairs

Double mesh repair in management of abdominal wall reconstruction for rectus diastasis and or ventral hernia repairs

Effects of Kinesiotaping along with abdomen and pelvic floor exercise on diastasis recti abdominis for postpartum women in normal delivery versus LSCS

Introduction and Aim: Women are prone to massive stretching on the abdomen at postpartum period. Hence, the need for the study is to determine the prevalence of diastasis recti abdominis at postpartum period. The aim of the study is to increase the abdominal strength among postpartum women with DRAM (Diastasis Recti Abdominis Muscle) by abdominal and pelvic floor exercise along with Kinesiotaping (KT). Methodology: A total of 50 subjects with diastasis recti were selected based on selection criteria, divided into two groups – group A with 25 subjects who have undergone Normal Vaginal Delivery (NVD) and group B with 25 subjects who have undergone Lower Section Caesarian Section (LSCS). The reason for the review was disclosed to the patient and definite concern was acquired, in view of particular testing technique. Pre-tests were done using Vernier calipers, followed with pre-test intervention procedures started with abdomen exercises (Abdominal tuck-in), SLR (Straight Leg Raise) and pelvic floor exercise (pelvic bridging and Kegel’s exercises). The activities were done for 30minutes each day 2 meetings for a considerable length of time. After the end of treatment, post-test was finished utilizing a similar result measure.In view of the information gathered from every one of the examples, measurable examination was finished. Results: On looking at pre and post-test inside group A and group B values, it showed identical distinction between group A and group B. Group A (KT with practice for NVD), showed better improvement. Additionally, group B (KT with practice for LSCS) showed a decent improvement yet not that as group A. Conclusion: This study concludes that abdominal exercises along with Kinesiotaping among postpartum women undergone NVD had considerable effects in reducing diastasis recti abdominis. It assists with increasing the abs strength and reestablishing post pregnancy stomach productivity.

Traumatic abdominal wall hernia in a patient with diastasis recti.

Traumatic abdominal wall hernia in a patient with diastasis recti.

312 Pelvic girdle pain early postpartum: Are there any associations with inter-pubic distance, diastasis recti and catastrophizing? A matched case-control study

Introduction and aims of the study: Pregnancy-related pelvic girdle pain (PGP) is experienced between the posterior iliac crest and the gluteal folds. The pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis. The endurance capacity for standing, walking, and sitting is diminished. Lack of accurate and early diagnosis of the PGP early postpartum may contribute to development of chronic condition, lowering quality of life years after delivery.

Σύγχρονη φυσιοθεραπευτική αντιμετώπιση της διάστασης του ορθού κοιλιακού σε γυναίκες μετά την εγκυμοσύνη

Diastasis recti abdominis (DRA) is a connective tissue impairment commonly seen in pregnant and postpartum women, causing significant physical and cosmetic concerns. Possible connections of DRA to several musculoskeletal dysfunctions, such as pelvic floor dysfunctions, pregnancy-related low back pain and impaired abdominal muscle strength have been postulated; thus, making DRA management important for the functionality and the quality of life of women following pregnancy. According to international guidelines, conservative management of DRA is the gold standard approach nowadays. However, there is no consensus in literature, about the most effective type of rehabilitation exercises for DRA. The aim of this review is to report current evidence on DRA rehabilitation as well as make suggestions for future clinical research.

Role of Exercise in Preventing Diastasis Recti in Pregnant Women

Objective: To see the effect of exercise in preventing diastasis recti in pregnant women.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Gynecology &amp; Obstetrics, Avicenna Medical College, Lahore Pakistan, from Jan to Dec 2019.&#x0D; Methodology: This study included 93 pregnant women who were randomized in two groups, exercise group and non-exercise group. The measurement for diastasis recti abdomen was taken at 3 locations: at the umbilicus, 5 cm above the umbilicus, and 5 cm below the umbilicus. Measurement for diastasis recti were done at the time of inclusion in study and 6 weeks after the termination of pregnancy.&#x0D; Results: The mean age of the women in our study was 26.5 ± 0.62 years. The frequency of diastasis recti was far less in exercising pregnant women as compared to non-exercising pregnant ladies after 6-weeks postpartum period. No diastasis recti was present at the supra-umbilical level in 34 (36.55%) women of exercise-group as compared to 9 (9.67%) in non-exercise group. At supra umbilical level, there was no diastasis recti present in 43 (46.2%) women of exercise-group as compared to 7 (7.52%) women in non-exercising groups at 6-weeks postpartum period. Similarly, no diastasis recti were present in 43 (46.2%) women of exercise-group as compared to 8 (8.60%) women in non-exercising group at infra umbilical level at 6 weeks postpartum period. Result showed that there was statistically significant improvement in the diastasis recti abdominis in exercise-group (p=0.002).&#x0D; Conclusion: Abdominal exercises help in reducing diastasis recti in pregnant women significantly as compared..............................

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

BackgroundThis study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty.Materials and methodsOne hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result.ResultsNo statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results.ConclusionsIn this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results.Level of evidence IVThis 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.