Management of the post-pregnancy abdomen: the plastic surgical perspective

Minimally invasive bilayer suturing technique for the repair of concomitant ventral hernias and diastasis recti

BACKGROUND

According to EHS guidelines, mesh repair is recommended in case of concomitant diastasis recti (DR) and ventral hernia more than 1 cm in diameter. Since in this situation, the higher risk of hernia recurrence may be attributed to the weakness of aponeurotic layers, in our current practice, for hernias up to 3 cm, we use a bilayer suture technique. The study aimed at describing our surgical technique and evaluating the results of our current practice.

METHODS

The technique combines suturing repair of the hernia orifice and diastasis correction by suture, and includes an open step through periumbilical incision and an endoscopic step. The study is an observational report on 77 cases of concomitant ventral hernias and DR.

RESULTS

The median diameter of the hernia orifice was 1.5 cm (0.8-3). The median inter-rectus distance was 60 mm (30-120) at rest and 38 mm (10-85) at leg raise at tape measurement and 43 mm (25-92) and 35 mm (25-85) at CT scan respectively. Postoperative complications involved 22 seromas (28.6%), 1 hematoma (1.3%) and 1 early diastasis recurrence (1.3%). At mid-term evaluation, with 19 (12-33) months follow-up, 75 (97.4%) patients were evaluated. There were no hernia recurrences and 2 (2.6%) diastasis recurrences. The patients rated the result of their operation as excellent or good in 92% and 80% of the cases at global and esthetic evaluations, respectively. The result was rated bad at esthetic evaluation in 20% of the cases because the skin appearance was flawed, due to discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer.

CONCLUSION

The technique provides effective repair of concomitant diastasis and ventral hernias up to 3 cm. Nevertheless, patients should be informed that the skin appearance can be flawed, because of the discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer.

Some Additional Data That Might Be Useful for Diastasis Recti Assessment

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.

Effect of Multichannel Convolutional Neural Network-Based Model on the Repair and Aesthetic Effect of Eye Plastic Surgery Patients

Objective

This study is aimed at exploring the impact of eye model based on multichannel convolutional neural network (CNN) on eye plastic surgery and aesthetic effect, thus formulating methods to improve the effect of eye plastic surgery.

Methods

A total of 64 patients who underwent pouch plastic surgery from January 2020 to March 2021 were selected as the research objects and were divided into observation group and control group by random number table method. The subjects in the observation group were evaluated by multichannel CNN-based eye model and doctors' experience, while those in the control group were evaluated by doctors' experience only, with 32 cases in both groups. Blepharoplasty, lower eyelid skin wrinkles, skin luster, and aesthetic scores were compared between the two groups.

Results

The similarity between the multichannel CNN model detected shape and the actual eye shape (98.78%) was considerably higher than that of the CNN model detected shape (78.65%) (P < 0.05). After treatment, the indexes of pouch degree, lower eyelid skin wrinkle, eyelid lacrimal sulcus, skin gloss, and aesthetic score in the observation group were better than those in the control group (P < 0.05). The incidence of complications in the observation group (13%) was considerably lower than that in the control group (28%) (P < 0.05).

Conclusion

The eye model based on the multichannel CNN model was helpful to improve the surgical repair and aesthetic effect of patients and can improve the occurrence of postoperative complications.