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Shen Y, Zhou X, He K, Cai Y, Zhu Y, Chen H, Ding H. Diastasis Recti Abdominis: A Practical and Effective Width-Length Classification Based on Ultrasound Measurements and its Clinical Validation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38864261 DOI: 10.1002/jum.16508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility. METHODS We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment. RESULTS The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%. CONCLUSIONS This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.
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Affiliation(s)
- Ye Shen
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiuling Zhou
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai He
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yehua Cai
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Yulan Zhu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Hao Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
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Jiang Q, Gao Y, Xia S, Gu Y, Gu J, Guo J, Feng G, Deng Q, Deng X. Intra- and Interimage Reliability of Inter-Rectus Distance Measurements Determined via Ultrasound Imaging by the Same or Different Testers in Women in the Early Postpartum Period. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1037-1044. [PMID: 38380860 DOI: 10.1002/jum.16430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES No consensus regarding the optimal position and location for the measurement of the inter-rectus distance (IRD) via ultrasound (US) has been reached. By investigating the intra- and interimage reliability of IRD measurements taken in different positions and at different locations within and between testers, this study provides a theoretical basis for the current situation. METHODS The IRD was measured via US in 46 women at 42-60 days after delivery at the superior margin of the umbilicus and 3 cm above, 5 cm above and 3 cm below the umbilicus while the women were in the supine, crunch and standing positions. In the interimage test, every participant was tested 2 times by Physician X and 1 time by Physician Y; in the intraimage test, the images collected by Physician X during the first test were saved in the machines, and two measurements were performed by Physician X and one measurement was performed by Physician Y. Paired t tests and intraclass correlation coefficients (ICCs) were calculated. RESULTS Only the first IRD measurements by tester X and tester Y at 3 cm below the umbilicus in the crunch position were significantly different (9.56 ± 6.00 versus 11.00 ± 5.55) (P < .05). All the ICCs were greater than .75, and the intratester ICCs were greater than or equal to the corresponding intertester ICCs. The ICCs at 3 cm below the umbilicus were the smallest in the supine and crunch positions and the largest in the standing position due to the increased frequency of IRD values of 0. The ICCs for the crunch position were greatest according to the intraimage test but smallest according to the interimage test. The interimage ICCs between the two testers in the supine position at the superior margin, 3 cm above, 5 cm above, and 3 cm below the umbilicus were .972, .974, .975, and .956, respectively. CONCLUSIONS Ultrasound imaging (USI) is a reliable method for measuring the IRD in women in the early postpartum period. The dynamic measurement of the IRD at or above the umbilicus in the supine position by different testers in real time showed the highest reliability.
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Affiliation(s)
- Qing Jiang
- Ultrasound Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Ya Gao
- Ultrasound Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Shuyu Xia
- The Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Yangzhou University, Xiangcheng People's Hospital, Suzhou, China
| | - Yuefan Gu
- Ultrasound Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Jun Gu
- Ultrasound Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Jianfeng Guo
- Ultrasound Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Guannan Feng
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qifeng Deng
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xuedong Deng
- Ultrasound Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
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Hubner P, Alberti L, Carvalho A, Soares V, Neto C, Garcia D. Morphometric evaluation of the linea alba in fresh corpses. JPRAS Open 2024; 40:238-244. [PMID: 38681533 PMCID: PMC11046057 DOI: 10.1016/j.jpra.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Diastasis recti abdominis is an increase in the distance between the medial borders of the two rectus muscles. It is most often triggered after intra-abdominal pressure increases, such as postpartum or in obesity. Most publications are based on radiological studies or are done in certain subgroups, without unanimous reference values of the distance between the rectus abdominis or standardization. Methods Forty-one cadavers were studied. Exclusion criteria: signs of abdominal trauma, major burns, presence of scar from previous abdominal surgery, clinical signs of abdominal hernia, and identification of hernia during cadaver dissection. Linea alba (LA) length, width, and thickness were measured with a flexible tape measure and digital caliper. Anatomical landmarks were established, and subdivisions were described based on them to compare the cadavers. Results Sex and age had little effect on LA width, thickness, or length. Obesity (compared to normal weight) was the only variable that promoted an increase in the LA width (p < 0.01). The supraumbilical length varied with the total height of the evaluated cadavers (p < 0.01), but the infraumbilical length did not (p = 0.11). Conclusion The general statistical results of this study, regarding the evaluation of LA measurements in cadavers, showed that ethnicity, sex, and age have little effect on the width, thickness, or length of the LA. LA width differed significantly with abdominal circumference.
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Affiliation(s)
- P.N.V. Hubner
- General Surgery, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | - L.R. Alberti
- Surgery, Santa casa BH and Federal University of Minas Gerais, Brazil
| | - A.C. Carvalho
- General Surgery, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | | | - C.S. Neto
- General Surgery and Trauma Surgery, Hospital Joao XXIII, Belo Horizonte, MG, Brazil
| | - D.P.C. Garcia
- General Surgery, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
- Anatomy and surgery department, Ciencias Médicas, MG, Brazil
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Marander V, Råheim M, Haukenes I, Theodorsen NM. Mothers' experiences living with diastasis recti abdominis - an interview study. BMC Womens Health 2024; 24:292. [PMID: 38760781 PMCID: PMC11100213 DOI: 10.1186/s12905-024-03131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Diastasis recti abdominis (DRA) is a common postpartum condition. Knowledge is scarce on how mothers perceive living with DRA. The interaction between healthcare providers and patients plays a significant role in shaping the healthcare service experience. Women suffering from typical women's diseases tend to experience not being taken seriously or listened to when seeking healthcare. The aim of this study was to explore mothers' experiences living with DRA. METHODS Semi-structured individual interviews were conducted with six Norwegian mothers, age 32-41, presenting with a clinically significant DRA. Topics discussed were how the condition is experienced, how it affects different aspects of day-to-day life and experiences with healthcare services. The data was analyzed using systematic text condensation. RESULTS DRA had an impact on everyday life among the mothers included in this study. Three major themes emerged: (I) The path to obtaining knowledge and understanding of DRA, (II) DRA - intertwined with health issues and physical limitations and (III) A changed belly - on self-image & social interactions. The mothers experienced uncertainties and frustration when trying to learn about DRA. The limited knowledge of the condition made it hard to differentiate if the experienced symptoms were caused by presence of DRA or from other health issues. Several mothers felt misunderstood. CONCLUSION DRA is a multifaceted condition affecting many aspects of day-to-day life in various dimensions, like physical, emotional, and social. This study contributes to a wider understanding of living with DRA, which might guide healthcare professionals in providing support for mothers with this condition.
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Affiliation(s)
- Viktoria Marander
- Department of Global Public Health and Primary Care, University of Bergen, Alrek helseklynge, blokk D, Årstadveien 17, Bergen, 5009, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Alrek helseklynge, blokk D, Årstadveien 17, Bergen, 5009, Norway
| | - Inger Haukenes
- Department of Global Public Health and Primary Care, University of Bergen, Alrek helseklynge, blokk D, Årstadveien 17, Bergen, 5009, Norway
- Research Unit for General Practice, NORCE - Norwegian Research Centre, Bergen, Norway
| | - Nina-Margrethe Theodorsen
- Department of Global Public Health and Primary Care, University of Bergen, Alrek helseklynge, blokk D, Årstadveien 17, Bergen, 5009, Norway.
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Gueroult P, Joppin V, Chaumoitre K, Di Bisceglie M, Masson C, Bege T. Linea alba 3D morphometric variability by CT scan exploration. Hernia 2024; 28:485-494. [PMID: 38177404 DOI: 10.1007/s10029-023-02939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics. METHODS Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients' CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured. RESULTS The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001-p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007). CONCLUSION This study provides an exhaustive 3D description of Linea alba's anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.
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Affiliation(s)
- P Gueroult
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France.
- Service de chirurgie viscérale et endocrinienne, Angers University Hospital, Rue Larrey, 49933, CEDEX 9, Angers, France.
| | - V Joppin
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - K Chaumoitre
- Department of Medical Imaging, Aix Marseille Univ, North Hospital, APHM, Marseille, France
- Anthropologie Biologique UMR 7268ADES, Aix Marseille Univ, Marseille, France
| | - M Di Bisceglie
- Department of Medical Imaging, Aix Marseille Univ, North Hospital, APHM, Marseille, France
| | - C Masson
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - T Bege
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
- Department of General Surgery, Aix Marseille Univ, North Hospital, APHM, Marseille, France
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Sartori A, Tfaily A, Botteri E, Andreuccetti J, Lauro E, Caliskan G, Verlato G, Di Leo A. Rectus muscle diastasis in Italian women: determinants of disease severity, and associated disorders. Front Surg 2024; 11:1360207. [PMID: 38529469 PMCID: PMC10961386 DOI: 10.3389/fsurg.2024.1360207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders. Methods In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model. Results Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m2 (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity. Conclusion The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.
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Affiliation(s)
- Alberto Sartori
- U.O. Chirurgia Generale e d'Urgenza, Ospedale Montebelluna, Montebelluna, Italy
| | - Ahmad Tfaily
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia, Montichiari, Italy
| | | | - Enrico Lauro
- U.O. Chirurgia Generale, Ospedale Civile Santa Maria del Carmine, Rovereto, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Alberto Di Leo
- U.O. Chirurgia Generale e Mininvasiva, Ospedale San Camillo, Trento, Italy
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Guo XH, Wang H, Chen SJ, Xie YJ, Liu RR. Multidimensional Ultrasound Evaluation of Diastasis Recti Abdominis During Different Gestational Periods. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:525-533. [PMID: 38050787 DOI: 10.1002/jum.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The purpose of this study is to explore the application value of two-dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of diastasis recti abdominis (DRA) during different gestational periods. METHODS A cohort of 202 gravidas that were examined in our hospital between June 2021 and September 2022 were selected for the purpose of the study, which included 26 cases with <14 weeks of pregnancy, 36 cases in the 14th-27th week of pregnancy, 36 cases in the 28th-34th week of pregnancy, 32 cases in the 35th-38th week of pregnancy, 45 cases at 42 days postpartum, and 27 cases at 3 months postpartum. The inter-rectus distance (IRD) and the thickness in each gestational period were measured, and Young's modulus of the rectus abdominis at different gestational periods was measured using SWE by two sonographers. The differences in IRD, thickness, and elasticity characteristics during different periods, and the correlation between rectus abdominis elasticity and IRD, thickness, body mass index (BMI), neonatal weight, and delivery mode were analyzed and compared. The consistency of SWE parameters obtained by different sonographers was also compared. RESULTS There were significant differences in IRD, thickness, and Young's modulus during different gestational periods (P = .000, P < .001, P < .001). Early postpartum IRD and Young's modulus did not restore to the level of early pregnancy (P < .001, P < .001), while the thickness of rectus abdominis was not significantly different from that of early pregnancy (P = .211). The Young's modulus of rectus abdominis was negatively correlated with the IRD (r = .515), positively correlated with the thickness of rectus abdominis (r = .408), and weakly negatively correlated with maternal BMI (r = -.296). There was no significant correlation with neonatal weight or delivery mode (P = .147, .648). The Bland-Altman plot showed that the two sonographers had good consistency in evaluating the elasticity of rectus abdominis by SWE. CONCLUSION The multidimensional evaluation of DRA by ultrasound is feasible and IRD and Young's modulus can be used to evaluate the postpartum recovery of DRA. The combination of the two can objectively reflect the severity of DRA morphology and function.
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Affiliation(s)
- Xiao-Han Guo
- Department of Ultrasonic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Hua Wang
- Department of Ultrasonic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Sheng-Jiang Chen
- Department of Ultrasonic, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Yu-Juan Xie
- Department of Ultrasonic, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Rui-Rui Liu
- Department of Ultrasonic, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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Zhu Y, Jiang L, Ye T, Liu Y, Sun L, Xiao L, Chen J, Wang T, Ren Y, Xu H, Zhao H, Mao X, Shen T. Risk Factors and Patient-Reported Outcomes in Chinese Women with Postpartum Diastasis Recti Abdominis: An Observational Study. Int J Womens Health 2024; 16:179-192. [PMID: 38313599 PMCID: PMC10838504 DOI: 10.2147/ijwh.s437088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose Diastasis recti abdominis (DRA) is a condition in which the linea alba is stretched and widened, and the abdominal muscles are separated from each other. DRA typically occurs in pregnant and postpartum women. We aimed to determine the risk factors and patient-reported outcomes (PROs) of DRA in Chinese postpartum women. Methods This observational study was conducted in Hangzhou Hospital of Traditional Chinese Medicine, and involved 534 women who filled out the following risk-factor and PRO questionnaires: SF-MPQ-2, SF-ICIQ, LDQ, EPDS, MBIS, HerQles, and SF-36 (all Chinese versions). The inter-recti distance was measured by palpation. Statistical analyses were performed using SPSS v25.0 software and the Mann-Whitney U-test, chi-square test, binary logistic regression analysis (for risk factors of DRA), and the Kendall and Spearman tests (for correlation analysis). Results After childbirth, 78.1% (417/534) of the enrolled women had DRA. Abdominal surgery (P = 0.002), number of pregnancies (P = 0.035), parity (P = 0.012), number of births (P = 0.02), fetal birth weight (P = 0.014), and waist-to-hip ratio in the supine position (P = 0.045) significantly differed between the DRA and non-DRA groups. Caesarean delivery was an independent risk factor for DRA. The PROs were significantly worse in the DRA group than in the non-DRA group. Conclusion Caesarean delivery was an independent risk factor for DRA. Women with DRA are more likely to have limited physical activity or function after childbirth, lower self-confidence, and a decreased quality of life.
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Affiliation(s)
- Ying Zhu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Liyuan Jiang
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310005, People’s Republic of China
| | - Tiantian Ye
- The 1st Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Yan Liu
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Li Sun
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310005, People’s Republic of China
| | - Lijuan Xiao
- Department of Rehabilitation, Chun’an County Hospital of Traditional Chinese Medicine, Chun’an, 311799, People’s Republic of China
| | - Jiayu Chen
- Department of Rehabilitation, Huzhou Central Hospital, Huzhou, 313099, People’s Republic of China
| | - Ting Wang
- The 3rd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Yinghua Ren
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Hongjun Xu
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Huihui Zhao
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Xiaozhen Mao
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Tiantian Shen
- Department of Acupuncture and Rehabilitation, Shengzhou Municipal Hospital of Traditional Chinese Medicine, Hangzhou, 312499, People’s Republic of China
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Canton SA. "Slim-Mesh" Technique for Diastasis Recti Abdominis, Including Obesity-Related Cases. JSLS 2024; 28:e2024.00003. [PMID: 38562947 PMCID: PMC10984376 DOI: 10.4293/jsls.2024.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background and Objective We operated on a series of mostly obese patients with diastasis recti abdominis using the "Slim-Mesh" technique to repair/reinforce the diastasis and linea alba/recti muscles without plicating and traumatizing them. Additional objectives were to decrease operation time and intra- and postoperative complications. Methods We considered T1 cases diastasis after pregnancy and T2 cases obesity (BMI ≥ 30 mg/kg2); D1, D2, and D3 when the diastasis measured 2-3, 3-5, and ≥ 5 cm, respectively; H0 and H1 without and concomitant umbilical and/or epigastric hernia, respectively. At our Department, between May 2010 and November 2022, 47 patients with diastasis recti were operated on with the "Slim-Mesh" technique to reinforce/repair the traumatized linea alba/recti muscles, without plicating them. This was a prospective (83%)-retrospective study. Results We studied 23 males and 24 females. Mean age and BMI was 58 years and 29 kg/m2, respectively. Groups D1, D2, and D3 comprised 6, 23 and 18 patients, respectively; groups T1, T2, H0 and H1 comprised 22, 25, 13 and 34 patients, respectively. Mean operation time for all cases was 100 minutes. Mean length of hospital stay was 2.3 days and follow-up time was 5 years. We had 6 late postoperative complications: 3 hernia recurrences and 3 trocar site hernias. Conclusion Considering the lack of agreement on the best surgery for diastasis recti abdominis repair, in our experience the "Slim-Mesh" technique is a valid, safe and easy-to-reproduce way to save, repair and reinforce linea alba/recti muscles in diastasis recti patients, including the obese population (53%).
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Affiliation(s)
- Silvio Alen Canton
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy. (Dr. Canton)
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Braga A, Galli L, Caccia G, Amato G, Papadia A, Torella M, Salvatore S, Scancarello C, Baruch Y, Serati M. Is Diastasis Recti Abdominis Rehabilitation after Childbirth Able to Prevent the Onset of Stress Urinary Incontinence? A Case-Control Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2182. [PMID: 38138285 PMCID: PMC10744874 DOI: 10.3390/medicina59122182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/26/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
| | - Livia Galli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
| | - Giulia Amato
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
- Department of Obstetrics and Gynecology, EOC-Civico Hospital, 6900 Lugano, Switzerland
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, 80100 Naples, Italy;
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (M.S.)
| | - Yoav Baruch
- Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (M.S.)
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Theodorsen NM, Moe-Nilssen R, Bø K, Haukenes I. Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy 2023; 121:13-20. [PMID: 37812848 DOI: 10.1016/j.physio.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/18/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). DESIGN Experimental longitudinal design. SETTING Physiotherapy clinic, primary health care. PARTICIPANTS Thirty-eight pregnant women with DRA ≥ 2.8 cm. INTERVENTIONS Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. MAIN OUTCOME MEASURES Change in IRD. RESULTS There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27-37 was a mean increase of 8 mm (95% CI: 6, 9). CONCLUSION Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Nina-Margrethe Theodorsen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway.
| | - Rolf Moe-Nilssen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
| | - Kari Bø
- Norwegian School of Sport Sciences, Department of Sports Medicine, Postboks 4014 Ullevål stadion, 0806 Oslo, Norway
| | - Inger Haukenes
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
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12
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Zhang S, Fu F, Li W, Ding T, Gu Y, Xie Z. Analysis of multisite surface electromyography characteristics of pelvic floor muscles in postpartum patients with diastasis recti abdominis. J Obstet Gynaecol Res 2023; 49:2938-2945. [PMID: 37667814 DOI: 10.1111/jog.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
AIM To explore the electrophysiological characteristics of the independent muscles in the pelvic floor muscle (PFM) group of postpartum women with diastasis recti abdominis (DRA) and analyze the correlation between the rectus abdominis interval and PFM function. METHODS A total of 133 women who underwent postpartum re-examination from August 2021 to July 2022 were collected. The participants were divided into DRA and control groups based on the occurrence of DRA on ultrasonography. General data of the participants were collected, and the multisite surface electromyography (sEMG) assessment of the PFMs was performed using a intravaginal novel airbag-type stretchable electrode array device developed by the team. The sEMG characteristics of the different PFMs in the two groups were compared, and the correlation between the maximum rectus abdominis interval and the sEMG parameters of different PFMs was analyzed. RESULTS There were no differences in the baseline demographics and incidence of pelvic floor dysfunction between the two groups (p > 0.05). The mean amplitude of vaginal sphincter endurance contraction in the DRA group was significantly lower than that in the control group (28.44 ± 15.59 vs. 22.03 [12.22, 28.00], p < 0.05). Spearman's rank correlation analysis showed a weak negative correlation between the maximum rectus abdominis interval and the endurance contraction mean amplitude of the urethral and external anal sphincters (r = -0.173, -0.217, p < 0.05). CONCLUSIONS Patients with DRA had weakened PFM endurance, and there was a weak negative correlation between the maximum rectus abdominis interval and the endurance contraction mean amplitude of the PFM.
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Affiliation(s)
- Shuang Zhang
- Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Feifei Fu
- Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Wenjuan Li
- Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Tian Ding
- Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Yili Gu
- Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Zhenwei Xie
- Pelvic Floor Disease Diagnosis and Treatment Center, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
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13
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Afaque MY, Qaseem SMD, Shah MA, Kujur M, Rab AZU, Rizvi SAA. Surgical Anatomy of Transversus Abdominis Muscle for Transversus Abdominis Release: A CT-Based Study in Three Patient Groups. World J Surg 2023; 47:2718-2723. [PMID: 37713128 DOI: 10.1007/s00268-023-07163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The anatomy of the transversus abdominis muscle and its aponeurosis is important in transversus abdominis release surgery. We studied the CT anatomy of the transversus abdominis muscle medial to the linea semilunaris at different levels in the abdomen and measured the thickness of this muscle. METHODS In this retrospective study, we analysed 150 abdominal computed tomography at L1, L3, and L5 vertebral levels corresponding to subxiphoid, umbilical, and suprapubic regions, respectively. The patients were divided into three groups based on age and sex: women aged 15-20 years (nulliparous), women aged 30-60 years (multiparous), and men aged 15-60 years, with each group having 50 patients. We compared the thickness of the TA muscle at the L1 level between men and women and between nulliparous and multiparous women. RESULTS Transversus abdominis muscle was consistently present medial to the linea semilunaris at L1 vertebral level in the subxiphoid region (150/150). At the L3 vertebral level in the mid-abdomen, only eight patients had the transversus abdominis muscle there (8/150, 5%). At the L5 vertebral level in the suprapubic region, no patient had the transversus abdominis muscle medial to the linea semilunaris. The mean thickness of the transversus abdominis muscle at the L1 level was 3.4 mm, and at the L3 level, it was 1.6 mm. There was no statistically significant difference in the transversus abdominis muscle thickness between the men and women; however, a significant difference was found between the nulliparous and multiparous women, with thinner TA muscle in later. CONCLUSION There is good transversus abdominis muscle bulk medial to the linea semilunaris for doing transversus abdominis muscle division in the upper abdomen. However, as we move towards the mid-abdomen, we have TA aponeurosis or rarely TA muscle of little bulk.
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Affiliation(s)
- Md Yusuf Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India.
| | | | - Mudasir Ashraf Shah
- Department of Radiodiagnosis, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - Maikal Kujur
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - Atia Zaka Ur Rab
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - Syed Amjad Ali Rizvi
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
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14
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Korona-Bailey J, Banaag A, Jones P, Nguyen DR, Koehlmoos TP. Frequency of Medical Claims for Diastasis Recti Abdominis Among U.S. Active Duty Service Women, 2016 to 2019. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:470-477. [PMID: 37818180 PMCID: PMC10561740 DOI: 10.1089/whr.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 10/12/2023]
Abstract
Background Diastasis recti abdominis (DRA) is a condition in pregnant and postpartum women. Proposed risk factors include age, sex, multiparity, cesarean delivery, diabetes, gestational weight gain, and high birth weight. This study aims to estimate the prevalence of DRA using medical claims data among U.S. active duty service women (ADSW) and determine associated risk factors. Materials and Methods We conducted a cross-sectional study of ADSW aged 18 years and older in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FYs) 2016 to 2019. Utilizing claims data, we identified ADSW with a diagnosis of DRA during the study period. Risk factors, including age, race, socioeconomic status, branch of service, military occupation, delivery type, and parity, were evaluated through descriptive statistics, chi-square tests, and logistic regression analysis. Results A total of 340,748 ADSW were identified during FYs 2016 to 2019, of whom 2,768 (0.81%) had a medical claim for DRA. Of those with deliveries during the study period, 1.41% were multiparous and 84.53% had a cesarean delivery. Increased risk of DRA was found in ages 30 to 39 years, Black women, ranks representing a higher socioeconomic status, and women with overweight and obese body mass indices. Conclusions Although the prevalence of DRA, defined as a medical claim for DRA, in the study population is low, subpopulations may be disproportionately affected by the condition. Further research could potentially detail the impact of DRA on the functional impairment and operational readiness of ADSW in the U.S. military and any possible means of prevention.
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Affiliation(s)
- Jessica Korona-Bailey
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Amanda Banaag
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Penelope Jones
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dana R. Nguyen
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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15
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Du J, Ye J, Fei H, Li M, He J, Liu Y, Liu L, Ye Y, Li J, Hou L, Xu Y, Zhang H, Zhang C, Li T. Relationship Between Gestational Diabetes Mellitus and Postpartum Diastasis Recti Abdominis in Women in the First Year Postdelivery. Phys Ther 2023; 103:pzad102. [PMID: 37774365 PMCID: PMC10661657 DOI: 10.1093/ptj/pzad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 05/15/2023] [Accepted: 07/09/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Postpartum diastasis recti abdominis (DRA) influences women's appearance and health. Gestational diabetes mellitus (GDM) can affect the structure of the rectus abdominis muscles. However, the relationship between GDM and postpartum DRA is unknown. The objective of this study was to investigate the relationship between GDM and postpartum DRA. METHODS This retrospective cohort study included 241 women in the first year postdelivery. Women with GDM were matched with those without GDM using propensity score matching. They underwent an oral glucose tolerance test during pregnancy and a random blood glucose test before delivery. At follow-up, DRA was diagnosed by palpation, and interrectus distance was measured using ultrasound to evaluate the severity of DRA. The strength of the rectus abdominis was evaluated using the manual muscle testing method. RESULTS Among the 241 participants, 174 (72.2%) had postpartum DRA, and 46 women with GDM were matched with 46 women without GDM on the basis of propensity scores. Women with GDM had higher odds of experiencing postpartum DRA (adjusted odds ratio = 4.792; 95% CI = 1.672 to 13.736) and larger interrectus distance values at the upper part of the rectus abdominis than those without GDM. There was a weak and positive correlation between the fasting oral glucose tolerance test level and the interrectus distance values (0.267 ≤ r ≤ 0.367). CONCLUSION GDM was associated with postpartum DRA in women in the first year of delivery. Women with GDM had larger interrectus distance values at the upper part of the rectus abdominis than those without GDM. The fasting oral glucose tolerance test level showed a positive and weak correlation with the severity of postpartum DRA. IMPACT Women with GDM have higher odds of experiencing postpartum DRA than those without GDM. The upper part of the rectus abdominis deserves increased focus during and after rehabilitation. Controlling the fasting oral glucose tolerance test level may help reduce the severity of postpartum DRA.
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Affiliation(s)
- Jingran Du
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Juntong Ye
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Fei
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Mengxiong Li
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Juan He
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yun Liu
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lixiang Liu
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yangliu Ye
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Juanhua Li
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Hou
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yang Xu
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Haixia Zhang
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Changlin Zhang
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Tian Li
- Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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16
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Hernandez A, Petersen R. Laparoscopic Ventral Hernia Repair. Surg Clin North Am 2023; 103:947-960. [PMID: 37709398 DOI: 10.1016/j.suc.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The laparoscopic approach to ventral hernia repair is a safe and effective approach for both elective and emergent repair. The preoperative technical considerations include assessment of incarceration and potential for extensive adhesiolysis, size of defect, and atypical hernia locations. Preoperative considerations include weight loss and lifestyle modification. There are multiple methods of fascial defect closure and mesh fixation that the surgeon may consider via a laparoscopic approach, making it adaptable to varying clinical scenarios and anatomic challenges. Compared with open repair laparoscopic repair is associated with reduced surgical wound site infection, and compared with robotic repair outcomes are similar.
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Affiliation(s)
- Alexandra Hernandez
- Department of Surgery, Division of General Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356410, Seattle, WA 98195, USA
| | - Rebecca Petersen
- Department of Surgery, Division of General Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356410, Seattle, WA 98195, USA.
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17
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Nervil GG, Paulsen JF, Kalstrup J, Deigaard S, Herbst I, Lambaa S, Hölmich L. Simple plication alleviates physical symptoms in patients with post-gestational rectus diastasis. Hernia 2023:10.1007/s10029-023-02814-y. [PMID: 37354279 PMCID: PMC10374809 DOI: 10.1007/s10029-023-02814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/25/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To evaluate our surgery for post-gestational rectus abdominis muscle diastasis using slowly absorbable monofilament suture and eight weeks of abdominal binder in terms of recurrence rate, complications, and effect on patients' physical and cosmetic complaints. METHOD In a retrospective cohort study, all 44 patients operated between 2014 and 2020 were invited to a follow-up using ultrasound, clinical examination, and questionnaires regarding symptoms before and after surgery. RESULTS 89% of invited patients participated, with a median follow-up of 36 months. There was one recurrence caused by severe postoperative nausea and vomiting, which was the most common complication. Most procedures were safe, but two patients experienced Clavien-Dindo grade 3 complications. Patients reported feeling limited or taking precautions after surgery for a median of 8.5 months. Of all included patients, four responded that the operation did not alleviate their primary complaint. The remaining 35 patients (90%) experienced complete or partial alleviation of their primary complaints and would undergo the procedure again if needed. CONCLUSION Post-gestational diastasis recti can be associated with a large number of physical symptoms and functional complaints and can safely be operated using a single running plication of the anterior rectus fascia with a slowly absorbable suture, with fair cosmetic results, excellent effect on symptoms, few complications and high levels of patient satisfaction. Future research must determine which symptoms and findings should indicate surgery.
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Affiliation(s)
- G G Nervil
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - J F Paulsen
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - J Kalstrup
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - S Deigaard
- Surgical Department, Herlev and Gentofte Hospital, Herlev, Denmark
| | - I Herbst
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - S Lambaa
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - L Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark.
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18
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Ugurlu C, Gok H, Sahin A, Bayar B, Olcucuoglu E, Kulacoglu H. Prevalence of rectus diastasis is higher in patients with inguinal hernia. Hernia 2023:10.1007/s10029-023-02820-0. [PMID: 37335520 DOI: 10.1007/s10029-023-02820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. MATERIAL AND METHODS Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. RESULTS A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. CONCLUSIONS The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.
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Affiliation(s)
- C Ugurlu
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, 60030, Tokat, Turkey.
| | - H Gok
- Department of General Surgery, Hernia Istanbul Comprehensive Hernia Center, Istanbul, Turkey
| | - A Sahin
- Department of General Surgery, University of Health Science, Konya City Hospital, Konya, Turkey
| | - B Bayar
- Department of General Surgery, Mus State Hospital, Mus, Turkey
| | - E Olcucuoglu
- Department of General Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - H Kulacoglu
- Department of General Surgery, Ankara Hernia Center, Ankara, Turkey
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Aiolfi A, Bona D, Gambero F, Sozzi A, Bonitta G, Rausa E, Bruni PG, Cavalli M, Campanelli G. What is the ideal mesh location for incisional hernia prevention during elective laparotomy? A network meta-analysis of randomized trials. Int J Surg 2023; 109:1373-1381. [PMID: 37026844 PMCID: PMC10389496 DOI: 10.1097/js9.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/26/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Incisional hernia (IH) represents an important complication after surgery. Prophylactic mesh reinforcement (PMR) with different mesh locations [onlay (OL), retromuscular (RM), preperitoneal (PP), and intraperitoneal (IP)] has been described to possibly reduce the risk of postoperative IH. However, data reporting the 'ideal' mesh location are sparse. The aim of this study was to evaluate the optimal mesh location for IH prevention during elective laparotomy. METHODS Systematic review and network meta-analysis of randomized controlled trials (RCTs). OL, RM, PP, IP, and no mesh (NM) were compared. The primary aim was postoperative IH. Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. RESULTS Fourteen RCTs (2332 patients) were included. Overall, 1052 (45.1%) had no mesh (NM) while 1280 (54.9%) underwent PMR stratified in IP ( n =344 pts), PP ( n =52 pts), RM ( n =463 pts), and OL ( n =421 pts) placement. Follow-up ranged from 12 months to 67 months. RM (RR=0.34; 95% CrI: 0.10-0.81) and OL (RR=0.15; 95% CrI: 0.044-0.35) were associated with significantly reduced IH RR compared to NM. A tendency toward reduced IH RR was noticed for PP versus NM (RR=0.16; 95% CrI: 0.018-1.01), while no differences were found for IP versus NM (RR=0.59; 95% CrI: 0.19-1.81). Seroma, hematoma, surgical site infection, 90-day mortality, operative time and hospital length of stay were comparable among treatments. CONCLUSIONS RM or OL mesh placement seems associated with reduced IH RR compared to NM. PP location appears promising; however, future studies are warranted to corroborate this preliminary indication.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Fabio Gambero
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Andrea Sozzi
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Emanuele Rausa
- General Surgery 1, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Piero G. Bruni
- Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan
| | - Marta Cavalli
- Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan
| | - Giampiero Campanelli
- Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan
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20
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Bayoux R, Gignoux B, Barani C, Mabrut JY, Mojallal A. Endoscopic treatment of diastasis recti: Training method and literature review. ANN CHIR PLAST ESTH 2023:S0294-1260(23)00016-X. [PMID: 37121846 DOI: 10.1016/j.anplas.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Endoscopic treatment of diastasis rectus abdominis offers the possibility of correcting the condition without complete abdominoplasty. The purpose of this study was to develop a training method on fresh cadavers models based on a literature review on this surgery. MATERIAL AND METHODS The endoscopic procedure considered involved the insertion of a 10mm suprapubic trocar and of 5mm trocars in each iliac fossae. The muscle suture is done using running barbed suture. The surgery was performed on eight fresh cadavers to estimate the learning curve for this intervention, which was estimated with the CUSUM method. A systematic literature review in the PubMed database was performed, and 20 articles that met the inclusion criteria were analyzed. RESULTS The learning curve threshold was reached after 6 operations and can be separated into two phases. The most common complication of this surgery is seroma, it is encountered in 3 to 27% of cases according to the studies. Diastasis recurrence is rare, occurring in less than 2% of cases. In comparison, open surgical treatment of diastasis recti is associated with a higher risk of hematoma, skin necrosis and longer operating times. Recurrence rates are similarly low after open and endoscopic repair. Mesh reinforcement is indicated in cases of diastasis wider than 5cm, diastasis recurrence, severe musculoaponeurotic laxity, or hernia larger than 1cm. CONCLUSION The data in the literature indicate that laparoscopic surgery is an efficient and safe approach to correct diastasis of the rectus muscles and can be offered by plastic surgeons to selected patients.
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Affiliation(s)
- Robin Bayoux
- Department of Plastic and Reconstructive Surgery, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, UCBL 1, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Benoit Gignoux
- Department of General, Visceral and Endocrine Surgery, Clinique de la Sauvegarde, 480, avenue Ben-Gourion, 69009 Lyon, France
| | - Camille Barani
- Department of Plastic and Reconstructive Surgery, Saint-Joseph-Saint-Luc Hospital, 20, quai Claude-Bernard, 69003 Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Ali Mojallal
- Department of Plastic and Reconstructive Surgery, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, UCBL 1, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France.
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21
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Kaya AK, Menek MY. Comparison of the Efficiency of Core Stabilization Exercises and Abdominal Corset in the Treatment of Postpartum Diastasis Recti Abdominis. Eur J Obstet Gynecol Reprod Biol 2023; 285:24-30. [PMID: 37031572 DOI: 10.1016/j.ejogrb.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/09/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To examine the feasibility of three physiotherapy interventions for the treatment of diastasis recti abdominis (DRA): core stabilization exercises, abdominal corset and a combination of exercise and abdominal corset. STUDY DESIGN Forty-five women 6 to 12 weeks postpartum who were diagnosed with DRA by a gynecologist/obstetrician were recruited for the study. The women were randomly divided into three groups: core stabilization exercises (1st group), the combination of exercise and abdominal corset (2nd group) and abdominal corset (3rd group). The treatment session for each group continued for 8 weeks. Outcome measurements were pain evaluation, inter-rectus distance (IRD) measured using ultrasound, trunk flexion strength and endurance, balance with open eyes/closed with a balance board, and Oswestry Disability Index (ODI). RESULTS Statistically significant difference was observed in all outcome measures except the balance eyes closed results in the first group (p < 0.05). There was a statistically significant difference in all outcome measures in the second group (p < 0.05). Also, there was a statistically significant difference in visual analog scale, trunk flexor endurance, IRD results, balance with open eyes and ODI results in the third group (p < 0.05). When the values pre and post-treatment between the groups were examined, a statistically significant change was observed in trunk flexion strength, trunk flexor endurance, and balance with open eyes/closed parameters (p < 0.05). CONCLUSIONS Physiotherapy interventions as core stabilization exercises and the abdominal corset can positively impact IRD, trunk flexion muscle strength and endurance, balance and disability in DRA management. The combination of exercise and corset was found more effective in the postpartum process.
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Affiliation(s)
- Ayse Kavasoglu Kaya
- Department of Obstetrics and Gynecology, Medipol University Camlica Hospital, 34810 Istanbul, Turkey.
| | - Merve Yilmaz Menek
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medipol University, 34810 Istanbul, Turkey.
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22
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Cavallaro G, Gazzanelli S, Iorio O, Iossa A, Giordano L, Esposito L, Crocetti D, Tarallo MR, Sibio S, Brauneis S, Polistena A. Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia. J Minim Access Surg 2023; 19:207-211. [PMID: 37056085 PMCID: PMC10246641 DOI: 10.4103/jmas.jmas_111_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/08/2022] [Accepted: 10/17/2022] [Indexed: 01/22/2023] Open
Abstract
Background There is still no consensus on perioperative pain control techniques in patients undergoing laparoscopic surgery; protocols of conventional therapy can be improved by the use of perioperative anaesthesiologic techniques, such as epidural or loco-regional analgesic administration as transversus abdominis plane (TAP) block. The aim of this evaluation was to investigate the role of laparoscopic-assisted TAP block during repair of diastasis recti associated with primary midline hernias in term of post-operative pain relief. Materials and Methods This was a retrospective evaluation of a prospectively maintained database including patients undergoing laparoscopic repair of diastasis recti associated with primary ventral hernia. Patients were divided into two groups: Group A patients (n = 34) received laparoscopic-assisted bilateral TAP-block of 7.5 mg/ml ropivacaine for each side and Group B patients (n = 29) received conventional post-operative therapy. All patients received 24 h infusion of 20 mg morphine; pain was checked at 6, 24 and 48 h after surgery by numeric rating scale (NRS) score. A rescue analgesia by was given if NRS score was >4 or on patient request. Results No differences in operative time, complications and post-operative stay, no complications related to TAP-block technique were found. Post-operative pain scores (determined by NRS) were found to be significantly different between groups. Group A patients showed a significant reduction in NRS score at 6, 24 and 48 h (P < 0.005) and in the number of patients requiring further analgesic drugs administration (P < 0.005) compared to Group B patients. Conclusions Laparoscopic-guided TAP-block can be considered safe and effective in the management of post-operative pain and in the reduction of analgesic need in patients undergoing laparoscopic repair of diastasis recti and ventral hernias. The non-randomised nature of the study and the lack of a consistent series of patients require further evaluations.
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Affiliation(s)
| | - Sergio Gazzanelli
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | - Olga Iorio
- Department of Surgery, General Surgery Unit, F. Spaziani Hospital, Frosinone, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Luca Giordano
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | - Luca Esposito
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | | | - Simone Sibio
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | | | - Andrea Polistena
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
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23
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Ngo P, Cossa JP, Gueroult S, Blum D, Pélissier E. Some Additional Data That Might Be Useful for Diastasis Recti Assessment. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10923. [PMID: 38312411 PMCID: PMC10831680 DOI: 10.3389/jaws.2023.10923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2024]
Abstract
Background: Diastasis recti (DR) is characterized by separation of both rectus muscles and protrusion of the median bulging, but besides median bulging DR can also entail global abdominal bulging. On other note, DR classification is based on the width of divarication, but measurement values are different at rest and at effort due to muscle contraction. Aim of the study is to provide additional features concerning the type of bulging and the width of divarication. Methods: Findings were retrospectively drawn from the data prospectively collected in the records of a continuous cohort of 105 patients (89 females, 16 males) referred for diastasis and concomitant ventral hernia repair. Results: There was a median bulging alone in 45 (42.9%) cases, a global bulging alone in 18 (17.1%) cases, both types combined in 37 (35.2%) cases and no bulging in 5 (4.8%). On 55 patients with a global bulging, 51 were females. Tape measurements values of DR width were closer to the values measured on the CT scan at leg raise than at rest. The differences were significant at rest as well as at leg raise. Though the difference at rest was highly significant (p = 0.000), the difference at effort was not far from being not significant (p = 0.049). Conclusion: Besides median bulging, presence or absence of the global bulging should be included in DR assessment. The difference between width of divarication at rest and on exertion raises the question of which value should be used for DR classification. The question is worth being debated.
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Affiliation(s)
- P. Ngo
- Institut de la Hernie, Paris, France
| | | | | | - D. Blum
- Établissement Français du Sang de Franche Comté, Besançon, France
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24
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Denizoglu Kulli H, Gurses HN. Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol 2022; 279:40-44. [DOI: 10.1016/j.ejogrb.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/11/2022] [Accepted: 10/01/2022] [Indexed: 11/28/2022]
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25
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Weingerl I, Kozinc Ž, Šarabon N. The Effects of Conservative Interventions for treating Diastasis Recti Abdominis in Postpartum Women: a Review with Meta-analysis. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:10. [PMCID: PMC9707186 DOI: 10.1007/s42399-022-01353-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Iva Weingerl
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
- University of Primorska, Andrej Marušič Institute, Muzejski Trg 2, 6000 Koper, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
- Human Health Department, InnoRenew CoE, Livade 6, 6310 Izola, Slovenia
- S2P, Science to Practice, Laboratory for Motor Control and Motor Behavior, LtdTehnološki Park 19, 1000 Ljubljana, Slovenia
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26
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Liu Y, Zhu Y, Jiang L, Lu C, Xiao L, Wang T, Chen J, Sun L, Deng L, Gu M, Zheng T, Feng M, Shi Y. Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: A randomized controlled clinical trial. Front Public Health 2022; 10:1003361. [PMID: 36483239 PMCID: PMC9724647 DOI: 10.3389/fpubh.2022.1003361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Electro-acupuncture (EA) has promising effects on diastasis rectus abdominis (DRA), defined as a separation of the two muscle bellies of rectus abdominis. To study, there is scant knowledge or scarce high-quality evidence. Objective We aimed to evaluate the long-term efficacy and safety of EA in treating DRA during postpartum. It was assumed that the improvement of DRA was more obvious in the EA group than in the control group. Design Randomized, controlled, blinded trial (Clinical Trial Registration: ChiCTR2100041891). Setting Hangzhou Hospital of Traditional Chinese Medicine in China. Participants Females aged 20-45 years without a past medical history of pathological rectus abdominal dissection were recruited from DRA inclusion criteria from 42 days to 1 year postpartum. Intervention 110 participants were randomly assigned in a 1:1 ratio to a control group with no EA intervention (n = 55), and EA group (n = 55). The EA group received ten sessions of EA combined with physical exercise or only physical exercise for 2 weeks with a 26-week follow-up. Measurements Outcomes were assessed at baseline, week 2, and week 26. The primary outcome was the change of the inter recti distance (IRD) and electromyographic evaluation of the pelvic floor. Secondary outcomes included elasticity of linea alba (LA), paraumbilical subcutaneous adipose tissue (SAT) measurement, body mass index (BMI), percentage body fat (F%), dyspepsia symptoms, menstrual symptoms, quality of life (QoL), pain performance of patients with lower back pain, postnatal depression symptoms (PDS), postpartum self-image, and DRA-related symptom assessment including urine leakage, frequency, and urgency, constipation, sexual dysfunction, and chronic pelvic pain. Results A total of 110 maternal (55 in each group) were recruited. The mean difference in IRD from baseline to week 2 and week 26 in all states of the two groups were reduced compared with those before treatment, with statistical significance (P < 0.05). The mean of IRD at the horizontal line of the umbilicus in the end-expiratory state was smaller in the EA group than in the control group, but the difference was not statistically significant (P > 0.05) at week 2. The mean of IRD at the horizontal line of the umbilicus in head-up and flexed knee state was smaller in the EA group than in the control group, and the difference was statistically significant (P < 0.05) at week 26. Five (9.1%) and thirteen (23.64%) adverse events were reported in EA and control groups, respectively. No serious adverse events were reported. Limitation The frequency intensity of EA parameters was selected between 4 and 6 because of individual tolerance differences. Conclusion EA is an effective approach to improve IRD, electromyographic evaluation of the pelvic floor, BMI, the elasticity of LA, paraumbilical SAT, and symptoms of DRA, with durable effects at 26 weeks. Primary funding source The Construction Fund of Medical Key Disciplines of Hangzhou (Project Number: OO20200097), Hangzhou Medical and Health Science and Technology Project No. A20200483, and Zhejiang Traditional Chinese Medicine Science and Technology Plan Project (Project Number: 2021ZQ065). Clinical trial registration http://www.chictr.org.cn/index.aspx, identifier: ChiCTR2100041891.
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Affiliation(s)
- Yan Liu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Zhu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Liyuan Jiang
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China,*Correspondence: Liyuan Jiang
| | - Chao Lu
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Lijuan Xiao
- Chun'an County Hospital of Traditional Chinese Medicine, Chun'an, China
| | - Ting Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiayu Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Sun
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Lujun Deng
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Meiyu Gu
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Tingting Zheng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Feng
- Department of Maternal Health Care, Maternity and Child Health Care Centers of Hechi, Hechi, China
| | - Yingying Shi
- Dingqiao Hospital of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
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27
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Diastasis recti is associated with incisional hernia after midline abdominal surgery. Hernia 2022; 27:363-371. [PMID: 36136228 DOI: 10.1007/s10029-022-02676-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE 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. METHODS 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 6 months prior to surgery and no less than 6 months 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 > 25 mm. RESULTS Of 156 patients, forty-four (28.2%) developed radiographic hernia > 1 cm. 36 of 85 patients (42.4%) with DR width > 25 mm 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. CONCLUSION 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.
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28
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Automatic Assessment of Abdominal Exercises for the Treatment of Diastasis Recti Abdominis Using Electromyography and Machine Learning. Symmetry (Basel) 2022. [DOI: 10.3390/sym14081654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diastasis Recti Abdominis (DRA) is a medical condition in which the two sides of the rectus abdominis muscle are separated by at least 2.7 cm. This happens when the collagen sheath that exists between the rectus muscles stretches beyond a certain limit. The recti muscles generally separate and move apart in pregnant women due to the development of fetus in the womb. In some cases, this intramuscular gap will not be closed on its own, leading to DRA. The primary treatment procedures of DRA involve different therapeutic exercises to reduce the inter-recti distance. However, it is tedious for the physiotherapists to constantly monitor the patients and ensure that the exercises are being done correctly. The objective of this research is to analyze the correctness of such performed exercises using electromyogram (EMG) signals and machine learning. To the best of our knowledge, this is the first work reporting the objective evaluation of rehabilitation exercises for DRA. Experimental studies indicate that the surface EMG signals were effective in classifying the correctly and incorrectly performed movements. An extensive analysis was carried out with different machine learning models for classification. It was inferred that the RUSBoosted Ensembled classifier was effective in differentiating these movements with an accuracy of 92.3%.
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29
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Aiolfi A, Cavalli M, Gambero F, Mini E, Lombardo F, Gordini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Prophylactic mesh reinforcement for midline incisional hernia prevention: systematic review and updated meta-analysis of randomized controlled trials. Hernia 2022; 27:213-224. [PMID: 35920944 DOI: 10.1007/s10029-022-02660-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/20/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Incisional hernia (IH) is a common complication after abdominal surgery. Prevention of IH is matter of intense research. Prophylactic mesh reinforcement (PMR) has been shown to be promising in the minimization of IH risk after elective midline laparotomy. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PMR vs. primary suture closure (PSC). Risk ratio (RR) and standardized mean difference (MD) were used as pooled effect size measures whereas 95% confidence intervals (95%CI) were used to assess relative inference. RESULTS Fourteen RCTs (2332 patients) were included. Overall, 1280 (54.9%) underwent PMR while 1052 (45.1%) PSC. Postoperative follow-up ranged from 12 to 67 months. The incidence of IH was reduced for PMR vs. PSC (13.4% vs. 27.5%). The estimated pooled IH RR for PMR vs. PSC is 0.38 (95% CI 0.24-0.58; p < 0.001). Stratified subgroup analysis according to mesh location shows a risk reduction for intraperitoneal (RR = 0.65; 95% CI 0.48-0.89), preperitoneal (RR = 0.18; 95% CI 0.04-0.81), retromuscular (RR = 0.47; 95% CI 0.24-0.92) and onlay (RR = 0.24; 95% CI 0.12-0.51) compared to PSC. The seroma RR was higher for PMR (RR = 2.05; p = 0.0008). No differences were found for hematoma (RR = 1.49; p = 0.34), surgical site infection (SSI) (RR = 1.17; p = 0.38), operative time (OT) (MD = 0.27; p = 0.413), and hospital length of stay (HLOS) (MD = -0.03; p = 0.237). CONCLUSIONS PMR seems effective in reducing the risk of IH after elective midline laparotomy compared to PSC in the medium-term follow-up. While the risk of postoperative seroma appears higher for PMR, hematoma, SSI, HLOS and OT seems comparable.
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Affiliation(s)
- A Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy.
| | - M Cavalli
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - F Gambero
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - E Mini
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - F Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - L Gordini
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - G Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - P G Bruni
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - D Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - G Campanelli
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
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30
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Letter to the editor: An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women? Int Urogynecol J 2021; 33:169. [PMID: 34842939 DOI: 10.1007/s00192-021-05041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
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31
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Huang LC, Wu CC, Kang YN. Comment on 'Do TEP and TAPP have similar effect on postoperative pain? Author's reply'. Hernia 2021; 25:1405-1406. [PMID: 34460017 DOI: 10.1007/s10029-021-02480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L-C Huang
- Department of Urology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - C-C Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Y-N Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei, 11696, Taiwan. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. .,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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