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Guerron AD, Restrepo-Rodas G, Barajas-Gamboa JS, Guzman Fuentes JL, Pantoja JP, Abril C, Al-Baqain S, Bravo M, Cherubino M, Rodriguez J. Diastasis Recti with Concomitant Ventral Hernia Repair: An Initial Experience in the United Arab Emirates Population. J Laparoendosc Adv Surg Tech A 2024. [PMID: 39172557 DOI: 10.1089/lap.2024.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Introduction: Diastasis recti (DR) is characterized by an abnormal separation between the rectus abdominis muscles. Traditional repair includes only plication; however, complications may arise in the presence of concurrent ventral hernias (VH). This study aims to evaluate the safety and feasibility of diastasis repair in a United Arab Emirates (UAE) population. Methods and Procedures: This retrospective cohort study was conducted with IRB approval. All patients who underwent a DR repair (DRR) with concomitant ventral hernia repair between October 2022 and February 2024 were included. Results: A total of 20 patients were included in the study. The cohort was 80% female, with a mean overall age of 44.05 years. The mean body mass index was 27.4 kg/m2. All patients (100%) presented with DR associated with an abdominal wall defect; 17 patients (85%) with umbilical hernia, 2 patients (10%) with umbilical and incisional hernia, and 1 patient (5%) with umbilical with epigastric hernia. A total of 12 (60%) patients underwent laparoscopic DRR concomitant with VH repair, 5 (25%) patients underwent open DRR with VH repair and abdominoplasty, and 1 patient (5%) underwent DRR with VH repair and liposuction. All cases were successful without complications or conversions. Complications within 30 days included only seromas in 6 patients (30%), one requiring drainage. Conclusion: Our initial experience suggests that DR repair with concomitant VH repair and/or abdominoplasty is feasible and safe in the UAE population. Our experience demonstrated surgical outcomes compared to other regions in the world.
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Affiliation(s)
- Alfredo D Guerron
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Juan S Barajas-Gamboa
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Juan Pablo Pantoja
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Suleiman Al-Baqain
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Miguel Bravo
- Department of Plastic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mario Cherubino
- Department of Plastic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - John Rodriguez
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Herold K, Stoddard T, Rodriguez-Unda N, LoGiudice J, Hettinger P, Higgins RM, Doren EL. Robotic Repair: An Alternative Technique for Rectus Diastasis and Abdominal Bulge Following DIEP Flap Breast Reconstruction. Aesthet Surg J 2024; 44:957-964. [PMID: 38500393 DOI: 10.1093/asj/sjae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Despite advances in perforator dissection, abdominal morbidity still occurs. Traditional rectus diastasis (RD), abdominal bulge, and hernia repair with open techniques are associated with higher complication rates and recurrence. OBJECTIVES We present a novel case series of robotic repair of symptomatic RD and/or abdominal bulge with concurrent hernia following DIEP flap surgery. METHODS A single-center, retrospective review was conducted of 10 patients who underwent bilateral DIEP flap breast reconstruction and subsequent robotic repair of RD and/or abdominal bulge and hernia. Preoperative demographics and postoperative clinical outcomes were reviewed. RD up to 5 cm, abdominal bulge, and any concurrent ventral/umbilical hernias were repaired robotically with retrorectus plication and macroporous mesh reinforcement. RESULTS The average age and BMI were 49 years (range 41-63) and 31 kg/m2 (range 26-44), respectively. The average number of perforators harvested per flap was 2.5 (range 1-4). Average RD and hernia size were 3.95 cm (range 2-5) and 5.8 cm2 (1-15), respectively. Eight patients stayed 1 night in the hospital, and 2 went home the same day as the robotic repair. No patients were converted to open technique and none experienced complications within 30 days. CONCLUSIONS For patients who experience donor site morbidity following DIEP flap breast reconstruction, minimally invasive robotic repair of RD and/or abdominal bulge with hernia can be performed with mesh reinforcement. This technique is effective, with low complication rates, and should be considered over open repair. LEVEL OF EVIDENCE: 4
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Swedenhammar E, Wahlström O, Brandt JD, Strigård K, Häger C, Stark B, Nyberg A. Reliability and validity of surface EMG assessments combined with isometric muscle strength testing in patients with abdominal rectus diastasis and asymptomatic controls. Hernia 2024; 28:1413-1426. [PMID: 38850377 PMCID: PMC11297106 DOI: 10.1007/s10029-024-03076-y] [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: 12/28/2023] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Patients with abdominal rectus diastasis (ARD) may have muscular functional impairments, but clinics lack appropriate objective assessment tools. The aim was to establish the relative and absolute reliability, and convergent validity, of muscular activity using Surface Electromyography (SEMG) during isometric abdominal muscle strength testing in patients with ARD and controls without ARD. METHODS Twenty-six patients with ARD were matched for age, sex and BMI with controls without ARD. Participants were tested twice during isometric muscular contractions using SEMG located on six abdominal sites. Mean amplitude, fatigue, and recruitment order were analyzed. Relative reliability was evaluated with Intraclass Correlation Coefficients (ICC), while absolute reliability was estimated by calculating the Standard Error of Measurement and Minimal Detectable Change. Convergent validity was addressed in relation to participant characteristics, functional ability, and symptoms. RESULTS Mean SEMG amplitude for all abdominal wall muscle contractions showed moderate to excellent relative test-retest reliability, with ICC values ranging from 0.46 to 0.97. In contrast, fatigue and recruitment order displayed poor to moderate relative reliability in both groups. Absolute reliability measures were generally high. A moderate to high convergent validity (ARD: rho-value 0.41-0.70; Controls: rho-value 0.41-0.75) was observed for mean amplitude in relation to a functional sit-to-stand test, abdominal circumference, BMI, back pain, and quality-of-life. CONCLUSIONS The results of applying SEMG during isometric abdominal muscle support practicing the method in clinics, although additional development is needed with further standardization and more functional testing. Furthermore, the method demonstrates construct validity in patients with ARD and in age- and sex-matched controls.
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Affiliation(s)
- E Swedenhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - O Wahlström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - J D Brandt
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences. Units: Surgery, Umeå University, Umeå, Sweden
| | - C Häger
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - B Stark
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Nyberg
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Zbar RI, Richards CR, Durbin RR, Wellington JM. Balancing Expectations: Navigating Medically Necessary Torso Procedures with Cosmetic Components in the Military Healthcare System. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5954. [PMID: 38983946 PMCID: PMC11233100 DOI: 10.1097/gox.0000000000005954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024]
Abstract
Background Surgeons performing federal insurance-financed procedures involving medically necessary and cosmetic components must navigate patient expectations to avoid postoperative disappointment. This challenge is amplified in military healthcare, where different surgical specialties concurrently address the same diagnosis, while the Department of Defense policy on cosmetic fees and TRICARE's definition of excluded services adds further complexity. With the increasing prevalence of elevated body mass index, focus is directed toward diagnoses involving the torso, specifically gynecomastia in male individuals, and diastasis of the rectus abdominis muscles (DRAM) in female individuals. Methods The study involves a team of experienced board-certified surgeons conducting a narrative review of surgical procedures addressing gynecomastia and DRAM. Relevant literature from 2000 to 2023 is reviewed, focusing on patient satisfaction regarding outcome of medically necessary and cosmetic aspects. Results For gynecomastia, distinguishing between true and pseudogynecomastia is critical. A protocol is presented based on the Simon classification, offering evidence-based guidelines for surgical interventions. Similarly, for DRAM, a minimally invasive approach balances deployment readiness and surgical recovery. The presence of a symptomatic panniculus, however, requires more invasive intervention. The downstream ramification of limited Current Procedural Terminology codes for these interventions is discussed. Conclusions In medically necessary procedures funded through federal health plans such as TRICARE, the primary goal is functional improvement, not the final torso contour. Clear communication and preoperative counseling are crucial to managing patient expectations. Providers in military healthcare must navigate the complex landscape of patient expectations, policy guidelines, and duty readiness while maintaining the standard of care.
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Affiliation(s)
- Ross I.S. Zbar
- From the Division of Plastic Surgery, Martin Army Community Hospital, Fort Moore, Ga
| | - Carly R.N. Richards
- Division of General Surgery, Department of Surgery, Martin Army Community Hospital, Fort Moore, Ga
| | - Ronald R. Durbin
- Division of General Surgery, Department of Surgery, Martin Army Community Hospital, Fort Moore, Ga
| | - Jennifer M. Wellington
- Division of General Surgery, Department of Surgery, Martin Army Community Hospital, Fort Moore, Ga
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Claus CMP, DI-Biasio GA, Ribeiro RD, Correa MAMF, Pagnoncelli B, Palmisano E. Minimally invasive lipoabdominoplasty (MILA) tactic. Rev Col Bras Cir 2024; 51:e20243692. [PMID: 38896637 DOI: 10.1590/0100-6991e-20243692-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/27/2024] [Indexed: 06/21/2024] Open
Abstract
While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.
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Affiliation(s)
| | | | | | | | | | - Ezequiel Palmisano
- - Instituto Metropolitano de Urologia, Hérnia e Diástase Abdominal - Rosário - Santa Fé - Argentina
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Tuominen R, Peltoniemi H, Jahkola T, Vironen J. An Abdominoplasty Modification for Postpregnancy Abdomen with Rectus Diastasis and Midline Hernia: The Technique and Results. Plast Reconstr Surg 2024; 153:1111e-1115e. [PMID: 37192371 PMCID: PMC11350177 DOI: 10.1097/prs.0000000000010637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/21/2022] [Indexed: 05/18/2023]
Abstract
SUMMARY After pregnancy, some women experience severe rectus diastasis (RD), with body control dysfunction, midline hernia, or other quality-of-life impairment. The purpose of this study was to describe the authors' experience using hydrodissection and epidural anesthesia for lateral plication modification of abdominoplasty to restore abdominal wall firmness. A total of 46 consecutive patients with RD after pregnancy were enrolled. The mean intraoperative inter-rectus distance was 4.6 cm. RD is not always the only structure that has been elongated. Firmness of the abdominal wall also depends on lateral fascia structures. This study reports the total plicated distance addressing the lateral laxity in the abdominal wall. In this series, total plication was 7.8 cm, and 16 patients had a midline hernia. No hernia recurrences occurred, and the rectus bellies were less than 5 mm apart from each other in all participants, verified with ultrasound after 2 years of follow-up. Patient perspective of care and surgical outcome were recorded. Health-related quality-of-life domains were significantly improved postoperatively. Lumbar back pain visual analogue scale score was 4.5 ± 2.3 preoperatively and 0.5 ± 0.9 postoperatively. The ability to perform sit-ups increased from zero to 11, suggesting better motor control. The total complication rate was 10.9%. Hydrodissection and epidural anesthesia for lateral plication modification offers a reliable and effective treatment method for RD repair with and without a small midline hernia with a low complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
| | | | | | - Jaana Vironen
- Abdominal Center, Helsinki University Hospital and University of Helsinki
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Moharaq KA, El Fahar MH, Shouman OO, Hassan AA, El-Shebly AM. Clinical and Radiological Evaluation of Onlay Mesh Abdominoplasty in Obese Multiparous Patients with Moderate-to-Severe Rectus Diastasis. Aesthetic Plast Surg 2024; 48:1778-1789. [PMID: 37978087 DOI: 10.1007/s00266-023-03743-y] [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: 08/22/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Women with multiple pregnancies often experience abdominal protrusion and/or a lax abdominal wall. Various open surgical techniques have been developed to address rectus diastasis in abdominoplasty, ranging from suture plication to mesh reinforcement. This study aims to compare the clinical and radiological changes between traditional abdominal plication and the addition of non-absorbable mesh for rectus muscle (RM) diastasis repair in terms of function, postoperative outcome, and recurrence. PATIENTS AND METHOD This prospective retrospective study involved 63 women who underwent cosmetic tummy tuck surgery and met certain eligibility criteria. Patients with only mild diastasis recti, midline hernia, contraindications for major surgery, recent smoking history, or refusal of mesh augmentation were excluded. Clinical examination for abdominal protrusion or bulging and CT imaging was performed to check for recurrence of diastasis recti. The study included 33 patients who underwent mesh repair and 30 who underwent traditional abdominal plication. Follow-up was conducted after 1 year using CT and a questionnaire to assess various factors compared to preoperative measurements, with overall satisfaction rated on a 10-point Likert scale. RESULTS There was no significant difference in demographic data between the two groups. Patients who underwent mesh repair had a slightly longer hospital stay and drain duration. The average waist circumference decreased in both groups without any statistically significant difference. Objective CT showed significant reductions in both groups in inter-rectus distance, RM width and circumference, and intra-abdominal circumference compared to preoperative values. All patients expressed satisfaction with scar quality and umbilicus aesthetics, and no recurrence was detected either clinically or radiologically during the follow-up period. CONCLUSION Comprehensive preoperative assessment and imaging techniques like ultrasound and CT scans allow surgeons to detect postpartum changes in the abdominal wall. Mesh reinforcement may be indicated for diastasis above 4 cm in obese multiparous females. Thorough preoperative evaluation permits customized surgical plans to optimally restore abdominal wall anatomy and function. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .
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Affiliation(s)
| | - Mohammed H El Fahar
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura Univeristy, 60 El Gomhoria St, Mansoura, 35516, Egypt.
| | - Omar O Shouman
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura Univeristy, 60 El Gomhoria St, Mansoura, 35516, Egypt
| | - Ahmed A Hassan
- Radiology Department, Faculty of Medicine, Mansoura University, 60 El Gomhoria St, Mansoura, 35516, Egypt
| | - Ahmed M El-Shebly
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura Univeristy, 60 El Gomhoria St, Mansoura, 35516, Egypt
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Fitzpatrick SE, Foley K, Crittenden T, Watson D, Dean NR. Australian women's experiences of post-partum rectus diastasis: A qualitative study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241233123. [PMID: 38577913 PMCID: PMC10998484 DOI: 10.1177/17455057241233123] [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: 08/22/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Post-partum rectus diastasis, or the separation of the abdominal muscles after pregnancy, occurs in conjunction with physical symptoms and impaired quality of life. In Australia, health funding for surgery to treat diastasis was ceased in 2016, but reinstated in mid-2022, providing a unique context from which women's experiences of this condition can be analysed. OBJECTIVES The objective is to examine the experiences of Australian women with post-partum rectus diastasis. DESIGN This is an interview-style study with qualitative content analysis. METHODS Women diagnosed with rectus diastasis were recruited to complete a baseline questionnaire (n = 45). Twenty-three responded to invitation for one-on-one interview via Zoom® between November 2021 and May 2022. Interviews were recorded, transcribed, and analysed using qualitative content analysis to identify key themes. RESULTS Eighteen women had undergone caesarean section and eight had twins. Thirteen had private health insurance. Women were most often diagnosed by a physiotherapist (n = 10). Key themes identified included changed physical appearance and function; issues with self-esteem and intimacy; barriers to treatment; lack of recognition as a medical condition; and overall frustration. The impact of rectus diastasis extended beyond physical and psychological symptoms to affect women's social functioning, child rearing, and return to work. There was a complex interaction between healthcare providers' knowledge of rectus the removal of funding for surgical treatment, and limitations of conservative therapy, with women's lived experiences and symptoms. The lack of an established medical definition also influenced the experiences of these women and their engagement with treatment. CONCLUSION This study contextualizes women's experience of post-partum rectus diastasis with respect to the unique landscape of Australia's healthcare economy and provides evidence of women's absorption of health policy surrounding this condition. Our qualitative analysis provides critical knowledge for future quantitative studies, the results of which in combination could advance the definition of rectus diastasis and inform healthcare policy surrounding treatment.
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Affiliation(s)
- Siobhan Elizabeth Fitzpatrick
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Kristen Foley
- Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, SA, Australia
| | - Tamara Crittenden
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - David Watson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Nicola R Dean
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, SA, Australia
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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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10
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Forester E, Sadiq A. Comparative analysis of the efficacy and functionality of abdominoplasty versus minimally invasive techniques in the surgical treatment of diastasis rectus abdominis in postpartum women. Surg Endosc 2023; 37:9052-9061. [PMID: 37950027 DOI: 10.1007/s00464-023-10540-w] [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: 04/23/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION This review aims to describe the surgical options available for treatment of diastasis recti in postpartum women, as well as compare the effectiveness of these treatment options. Historically, diastasis recti has been repaired through open procedures, such as abdominoplasty. More recently, studies have explored other methods for the treatment of diastasis recti, including various minimally invasive surgical options. METHODS Twelve studies ranging from 2015 to 2022 were included in this analysis. Studies were identified using PubMed, EMBASE, and Cochrane Library. Studies that met the inclusion criteria were analyzed descriptively. Statistical comparison of surgical outcomes between studies was performed using Fisher's Exact Test in SPSS. RESULTS Minimally invasive approaches were categorized as laparoscopic preaponeurotic approaches, robotic approaches, and enhanced-view/extended totally extraperitoneal (eTEP) approaches. These techniques were compared to two open approaches: abdominoplasty and miniabdominoplasty. There were no significant differences in the rate of seromas, surgical site infections/complications, or hematomas between abdominoplasty and minimally invasive surgical techniques (p > 0.05). Among the minimally invasive techniques, no significant differences in readmission rates were reported (p > 0.05). Additionally, no significant differences in recurrence rates were seen following minimally invasive or abdominoplasty repairs, except for the increased recurrence rates seen with the r-TARRD robotic technique (p < 0.05). CONCLUSION Although current data on minimally invasive approaches is limited, our review reveals that both open and minimally invasive approaches are viable options for diastasis recti repair in postpartum women. Identifying the optimal approach for diastasis recti repair should rely on the patient's desired treatment outcome. If the patient indicates a desire for the removal of excess abdominal subcutaneous tissue, abdominoplasty may be a better surgical approach. Alternatively, if the patient puts a greater emphasis on shorter recovery time and smaller surgical incisions/scars, minimally invasive approaches may be a better surgical option.
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Affiliation(s)
- Emily Forester
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA.
| | - Aziz Sadiq
- Virtua Health, General Surgery, Voorhees, NJ, USA
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11
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Blankensteijn LL, Hockx M, Mullender M, Bouman MB, Melenhorst WBWH. Clinical significance of diastasis recti: Literature review and awareness amongst health care professionals. J Plast Reconstr Aesthet Surg 2023; 84:439-446. [PMID: 37413736 DOI: 10.1016/j.bjps.2023.06.005] [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: 01/03/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND A variety of physical complaints have been related to chronic diastasis recti (DR), including back pain, pelvic pain, and urinary incontinence. However, its clinical significance is still subject of debate, leaving many patients to feel unheard when experiencing symptoms. This study aims to assess current knowledge on DR, its potential treatments, and the awareness of this condition amongst involved health care professionals. METHODS A literature review was performed to analyze current available knowledge on DR and its treatment. Then, a survey was conducted to investigate the awareness on DR amongst general practitioners, midwives, gynecologists, general surgeons, and plastic surgeons. RESULTS Over 500 health care professionals completed our survey, including 46 general practitioners, 39 midwives, 249 gynecologists, 33 general surgeons, and 74 plastic surgeons. Although the majority of respondents (>78% in all groups) reported to encounter DR in daily practice, opinions differed markedly on most significant symptoms, associated physical complaints, best first referral for treatment, and best treatment modality. CONCLUSION Current literature is not unanimous on the relation between DR and physical complaints and on its most suitable treatment. This incongruity is corroborated by the variety of responses from involved health care professionals in our survey. More clinical data are needed to provide clarity on this issue.
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Affiliation(s)
- Louise L Blankensteijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands.
| | - Miriam Hockx
- Mom's Planet Physiotherapy Practice, Planetensingel 71, 2402 AB Alphen aan den Rijn, the Netherlands
| | - Margriet Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Wynand B W H Melenhorst
- Department of Plastic, Reconstructive and Hand Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands
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12
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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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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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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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15
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Vicente-Campos V, Fuentes-Aparicio L, Rejano-Campo M. [Evaluation of the physical and psychosocial consequences of the diastasis of the rectus abdominis and its interference in health: A mixed study]. Rehabilitacion (Madr) 2023; 57:100744. [PMID: 35760642 DOI: 10.1016/j.rh.2022.03.006] [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: 01/13/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Diastasis rectus abdominis (DRA) is defined as the separation of the rectus abdominis along the linea alba. This condition can occur in both sexes, being frequent in women during pregnancy and pospartum. There is little evidence on the consequences of DRA on the quality of life of women. OBJECTIVE The analysis of the perception of the symptoms of and its repercussion on a physical, psychological and social level in women affected by this condition. PATIENTS AND METHODS Observational study through a semi-structured online survey, composed of 30 closed questions and 2 open ones. The inclusion criteria were adult Spanish-speaking women who had given birth and who presented abdominal diástasis. The data were analyzed quantitatively and the qualitative information was obtained through a content analysis of the open questions. RESULTS 319 women with DRA were included. The results showed a negative effect of DRA on quality of life, functional capacities, and urogynecological and digestive health. Likewise, a negative impact was evidenced at an emotional level, on body image and poor self-perceived health. CONCLUSION DRA has a negative impact on women's health. Women with DRA present an impairment of the quality of life and functional capacities, an alteration in body image, feelings of abandonment by health institutions, shame, sadness, powerlessness, lack of self-esteem, resignation and social pressure.
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Affiliation(s)
| | - L Fuentes-Aparicio
- Grupo investigación Multiespecialidad (PTinMOTION), Departamento de Fisioterapia, Universidad de Valencia, Valencia, España.
| | - M Rejano-Campo
- Montse Rejano Fisioterapeuta, El Puertillo, Las Palmas, España
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Olsson A, Woxnerud K, Kiwanuka O, Sandblom G, Stackelberg O. The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery. BJS Open 2023; 7:7025466. [PMID: 36734959 PMCID: PMC9897176 DOI: 10.1093/bjsopen/zrac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. METHODS A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. RESULTS Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. CONCLUSIONS Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.
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Affiliation(s)
- A Olsson
- Correspondence to: Anders Olsson, PhD, Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden (e-mail: )
| | - K Woxnerud
- Stockholm Hernia Center, Stockholm, Sweden,Women's Health Department, Hela Kvinnans Klinik, Stockholm, Sweden
| | - O Kiwanuka
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden,Unit of Nutritional Epidemiology, Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Vesting S, Gutke A, Fagevik Olsén M, Praetorius Björk M, Rembeck G, Larsson MEH. Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain? A Prospective Cohort Study. Phys Ther 2022; 103:pzac152. [PMID: 36326139 PMCID: PMC10071582 DOI: 10.1093/ptj/pzac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. METHODS Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. RESULTS Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. CONCLUSION The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. IMPACT This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.
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Affiliation(s)
- Sabine Vesting
- Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcus Praetorius Björk
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
- Department of Research, Education and Innovation, Region Västra Götaland, South Älvsborg Hospital, Borås, Sweden
| | - Gun Rembeck
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Borås, Sweden
- Region Västra Götaland, Regional Health, Borås Youth Guidance Center, Borås, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
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Bixo L, Sandblom G, Österberg J, Stackelberg O, Bewö K, Olsson A. Association Between Inter-Recti Distance and Impaired Abdominal Core Function in Post-Partum Women With Diastasis Recti Abdominis. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10909. [PMID: 38314149 PMCID: PMC10831648 DOI: 10.3389/jaws.2022.10909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 02/06/2024]
Abstract
Background and Aim: The definition and management of Diastasis Recti Abdominis (DRA) is under debate. This study aimed to understand the correlation between the post-partum inter-recti distance (IRD) and functional impairments associated with core instability, with the hypothesis that IRD could serve as a proxy for core instability symptoms and constitute a tool in decision-making for DRA treatment. Material and Methods: A cohort of post-partum women with abdominal core instability symptoms combined with DRA were studied. The size of IRD was measured with ultrasonography and cross-sectionally analysed against functional impairments registered with the self-report Disability Rating Index (DRI), which grades the ability to perform 12 different daily activities. Results: A total of 224 women were included in the study. In univariable analysis, IRD was associated with impairment of the activities running (p = 0.007), heavy work (p = 0.036) and exercise/sports (p = 0.047), but not with dressing, walking, sitting for long periods, standing bent over a sink, carrying a suitcase, making a bed, light manual labour or heavy lifting. No significant correlations were seen in the multivariable analysis when adjustments were made for BMI and parity. Conclusion: IRD and post-partum functional impairments had no significant correlation in multivariable analysis. The post-partum core instability condition is complex and probably associated with more factors than solely the IRD. The IRD alone does not seem to be a sufficient proxy for decision-making regarding optimal treatment. A more complete instrument to assess the post-partum abdominal core is warranted.
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Affiliation(s)
- L. Bixo
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - G. Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - J. Österberg
- Department of Surgery, Mora Hospital, Mora, Sweden
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - O. Stackelberg
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K. Bewö
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - A. Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Stockholm Hernia Center, Stockholm, Sweden
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PUELLES Á, GONZÁLEZ J, PIZARRO A, GALLEGUILLOS F, TORRES C, FABREGA A. Ultrasound analysis of morphological changes in the abdominal wall in postpartum women with diastasis recti: a cross-sectional study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Efficacy and Challenges in the Treatment of Diastasis Recti Abdominis—A Scoping Review on the Current Trends and Future Perspectives. Diagnostics (Basel) 2022; 12:diagnostics12092044. [PMID: 36140446 PMCID: PMC9498119 DOI: 10.3390/diagnostics12092044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/02/2022] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
Diastasis recti abdominis (DRA) is more prevalent in women during pregnancy and postpartum. However, there is a lack of awareness regarding this condition among women. The prevalence of DRA is high in late pregnancy and reduces during postpartum. The purpose of this study is to provide an overview of the treatment strategies for DRA and to discuss the significance of the technology towards better diagnosis and treatment. This work investigated 77 research articles published in the recognized research databases. The study aims to analyze the diagnostic and treatment procedures and the role of technology within them. The management strategy for DRA can either be conservative or surgical. Exercise therapy has been shown to improve functional impairments. These exercises focus on recruiting the abdominal muscles. Electromyography and Ultrasound imaging have been employed as useful tools in assessing the abdominal muscles effectively. This study has examined the treatment methods for DRA to obtain a better understanding of the existing methods. Further investigation and experimentation into therapeutic exercises is strongly recommended to identify the best set of exercises for a faster resolution. Further studies regarding the role of technology to assess therapeutic exercises would be worthwhile.
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Adams ST, Bedwani NH, Massey LH, Bhargava A, Byrne C, Jensen KK, Smart NJ, Walsh CJ. Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence. Hernia 2022; 26:701-714. [PMID: 35024980 DOI: 10.1007/s10029-022-02562-5] [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: 10/24/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic. METHODS Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors' choosing. Inclusion-cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a "prehabilitation" and/or "rehabilitation" program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group's data extraction template. RESULTS The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included-two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible-two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported. CONCLUSIONS The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.
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Affiliation(s)
- S T Adams
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, CH49 5PE, Wirral, UK.
- Department of General Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Rainhill, Prescot, UK.
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Rainhill, Prescot, UK.
| | - N H Bedwani
- Department of General Surgery, North Middlesex University Hospital NHS Trust, London, UK
| | - L H Massey
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Bhargava
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - C Byrne
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - K K Jensen
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - C J Walsh
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, CH49 5PE, Wirral, UK
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Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates. World J Surg 2022; 46:1878-1885. [DOI: 10.1007/s00268-022-06550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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Tuominen R, Jahkola T, Saisto T, Arokoski J, Vironen J. The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study. Hernia 2022; 26:599-608. [PMID: 34432175 PMCID: PMC9012726 DOI: 10.1007/s10029-021-02484-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Post-pregnancy abdominal rectus diastasis (ARD) has raised attention in the field of surgery in recent years, but there is no consensus about when to consider surgery. Our aim was to find out what is the normal inter-rectus distance in fertile aged, female population in Finland and to examine whether there is a linea alba width that would predispose to diastasis-related problems after pregnancy. METHODS For this prospective cohort study, women participating early pregnancy ultrasound in Helsinki University Hospital Department of Obstetrics and Gynecology during 1.1.2018-8.3.2019, were recruited. The width of linea alba was measured by ultrasound during the early pregnancy ultrasound. Symptoms were measured by questionnaire including Health-Related Quality of Life (RAND-36) and Oswestry Disability Index for back symptoms and disability. RESULTS Linea alba width was measured in total of 933 women. The average inter-rectus distance (IRD) among nulliparous women was 1.81 ± 0.72 cm. After one previous pregnancy, the average linea alba width was 2.36 cm ± 0.83 cm and after more pregnancies 2.55 ± 1.09 cm. There was a positive correlation between previous pregnancies and the increased linea alba width (p = 0.00004). We did not perceive any threshold value of linea alba width that would predispose to back pain or movement control problems in this cohort, in which severe diastasis (over 5 cm) was rare. CONCLUSION Mean inter-rectus distance in parous population exceeds stated normative values. Moderate ARD (3.0-5.0 cm) alone does not seem to explain low back pain or functional disability in population level. Severe post-pregnancy diastasis (over 5.0 cm) is rare.
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Affiliation(s)
- R Tuominen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, PL 266, 00029 HUS, Helsinki, Finland.
| | - T Jahkola
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, PL 266, 00029 HUS, Helsinki, Finland
| | - T Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Vironen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Dean NR, Foley K, Long R, Ward P. Experiences of women undergoing abdominoplasty in the public sector: a qualitative study. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: This study was designed to improve understanding of the experiences of women un-dergoing abdominoplasty in a public hospital setting, including their experience of processes of care, surgical treatment and outcomes of surgery.
Methods: This was a prospective, qualitative study, with one-to-one interviews with women, tran-scription of interviews and development of themes.
Results: Twenty interviews were carried out with 16 women, with four women being interviewed before and after surgery and the remaining 12 being interviewed one time only. Messages emerging from the interviews included gratitude for treatment in the public sector, uncertainty associated with waiting times and surgeon allocation, and varied satisfaction with outcomes. This article also explores the evidence for the association between physical symptoms and rectus diastasis (separa-tion of the rectus abdominis muscles) as well as mental health improvement.
Conclusion: Women undergoing abdominoplasty in the public sector are not a homogenous group, either in their motivations for surgery or their reported outcomes. This qualitative study found evidence for improvement in physical symptoms and psychological wellbeing in women undergoing abdominoplasty, which supports existing quantitative studies, but also highlights a need for clear information for public sector patients, especially relating to scars, and for liaison psy-chiatry. Criteria-based assessment contributes an additional burden for these patients.
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Yuan S, Li Y, Li Q, Fan L, Zhou J. Surgery Versus Non-surgery Interventions on Rectus Abdominis Diastasis With or Without Hernias: a Systematic Review. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zhou Z, Yan L, Li Y, Zhou J, Ma Y, Tong C. Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance. Surg Radiol Anat 2022; 44:1531-1543. [PMID: 36404360 PMCID: PMC9734211 DOI: 10.1007/s00276-022-03046-y] [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: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Many researchers have different views on the origin and anatomy of the preperitoneal fascia. The purpose of this study is to review studies on the anatomy related to the preperitoneal fascia and to investigate the origin, structure, and clinical significance of the preperitoneal fascia in conjunction with previous anatomical findings of the genitourinary fascia, using the embryogenesis of the genitourinary system as a guide. METHODS Publications on the preperitoneal and genitourinary fascia are reviewed, with emphasis on the anatomy of the preperitoneal fascia and its relationship to the embryonic development of the genitourinary organs. We also describe previous anatomical studies of the genitourinary fascia in the inguinal region through the fixation of formalin-fixed cadavers. RESULTS Published literature on the origin, structure, and distribution of the preperitoneal fascia is sometimes inconsistent. However, studies on the urogenital fascia provide more than sufficient evidence that the formation of the preperitoneal fascia is closely related to the embryonic development of the urogenital fascia and its tegument. Combined with previous anatomical studies of the genitourinary fascia in the inguinal region of formalin-fixed cadavers showed that there is a complete fascial system. This fascial system moves from the retroperitoneum to the anterior peritoneum as the preperitoneal fascia. CONCLUSIONS We can assume that the preperitoneal fascia (PPF) is continuous with the retroperitoneal renal fascia, ureter and its accessory vessels, lymphatic vessels, peritoneum of the bladder, internal spermatic fascia, and other peritoneal and pelvic urogenital organ surfaces, which means that the urogenital fascia (UGF) is a complete fascial system, which migrates into PPF in the preperitoneal space and the internal spermatic fascia in the inguinal canal.
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Affiliation(s)
- Zheqi Zhou
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China ,grid.440747.40000 0001 0473 0092Yan’an University, Yan’an, China
| | - Likun Yan
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Yi Li
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Jinsong Zhou
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Yanbing Ma
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Cong Tong
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
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Hu J, Gu J, Yu Z, Yang X, Fan J, You L, Hua Q, Zhao Y, Yan Y, Bai W, Xu Z, You L, Chen C. Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women. Int J Gen Med 2021; 14:10373-10383. [PMID: 35002294 PMCID: PMC8721020 DOI: 10.2147/ijgm.s348135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Jing Hu
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Juanfen Gu
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Zhiyan Yu
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Xianxu Yang
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Jian Fan
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Lingying You
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Qinyan Hua
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Yuting Zhao
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Yuerong Yan
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Weiwei Bai
- Department of Ultrasound, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Zipeng Xu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Lina You
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
- Correspondence: Lina You; Chaobo Chen Tel +86 13812052853; +86 13585000831 Email ;
| | - Chaobo Chen
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
- Department of Immunology, Ophthalmology and ORL, Complutense University School of Medicine, Madrid, 28040, Spain
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Yuan S, Wang H, Zhou J. Prevalence and Risk Factors of Hernia in Patients With Rectus Abdominis Diastasis: A 10-Year Multicenter Retrospective Study. Front Surg 2021; 8:730875. [PMID: 34604296 PMCID: PMC8481825 DOI: 10.3389/fsurg.2021.730875] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Hernias are very common in patients with rectus abdominis diastasis (RAD). This study aimed to identify and compare the risk factors and patterns of hernia between men and women with RAD. Method: We included patients with RAD from six hospitals within the Partners Healthcare System in Massachusetts, USA between 2009 and 2018. Univariate and multivariable binary logistic regression analyses were used to identify risk factors associated with hernia. Results: Of the 1,294 RAD cases, 866 (67%) were women. The risk of RAD in women was 1.9 times greater than that of men. There were 240 men (56.1%) and 310 women (35.8%) having one or more hernia (P < 0.001). Of the 550 hernia cases, 278 men and 175 women had umbilical hernia (28.1 vs. 38.3%, P = 0.085). The distribution of hernia type differed between the two groups (P < 0.0001). Multivariate analysis identified that alcohol use [odd ratio (OR) 1.74 (1.17-2.59); P = 0.006] and depressive disorder [OR 1.90 (1.209-2.998); P = 0.005] were risk factors of coexisting hernia for men with RAD; age [OR 1.51 (1.33-1.72); P = 0.000] and smoking/tobacco use [OR 1.66 (1.13-2.44); P = 0.010] were risk factors of hernia for women. Conclusion: The prevalence and risk factors of hernia in women with RAD significantly differed from that in men with RAD. Umbilical hernia is an important type of hernia. Alcohol use and depressive disorder in men, and age and smoking in women were risk factors of hernias in patients with RAD.
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Affiliation(s)
- Sue Yuan
- Xiangya Nursing School, Central South University, Changsha, China.,Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Olsson A, Kiwanuka O, Wilhelmsson S, Sandblom G, Stackelberg O. Surgical repair of diastasis recti abdominis provides long-term improvement of abdominal core function and quality of life: a 3-year follow-up. BJS Open 2021; 5:6369782. [PMID: 34518875 PMCID: PMC8438255 DOI: 10.1093/bjsopen/zrab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background Diastasis recti abdominis (DRA) is a condition affecting many post-partum women. The aim of this study was to evaluate long-term results of surgical repair of DRA in a cohort of post-partum women. Methods Sixty post-partum women with DRA and training-resistant core dysfunctions were included. Surgical repair was performed with suture plication of the linea alba. Abdominal core function was evaluated with the abdominal trunk function protocol (ATFP) including a self-report questionnaire and seven functional tests. Urinary incontinence and quality of life were evaluated with the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the SF-36 questionnaire. Follow-up was performed at 1 and 3 years after surgery. Results Response rate at the 3-year follow-up was 86.7 per cent for the disability rating index (DRI) questionnaire; and 71.7 per cent for the ATFP, UDI-6, IIQ-7 and SF-36 questionnaires. All DRI parameters were improved (P < 0.001) after 3 years of follow-up compared with preoperative values. The functional tests in the ATFP showed an improvement in core muscle strength and stability (P < 0.001), back muscle strength (P < 0.001) and abdominal muscle strength (P = 0.002) compared to preoperative values as well as an improvement of core muscle strength and stability compared with the 1-year follow-up values (P = 0.003). UDI-6 and IIQ-7 results were improved (P < 0.001 and P = 0.004) compared with preoperative values and showed consistent values compared with the 1-year follow-up (P = 0.09 and P = 1.0). Quality of life measured with SF-36 was improved compared with preoperative values and showed consistent values compared with the 1-year follow-up. Conclusion The functional improvement of surgical reconstruction of the DRA persisted for 3 years in this series of post-partum women with DRA.
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Affiliation(s)
- Anders Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Olivia Kiwanuka
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Sofia Wilhelmsson
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Otto Stackelberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Dumanian GA, Moradian S. Mesh abdominoplasty for rectus diastasis in women and men. Hernia 2021; 25:863-870. [PMID: 34342745 PMCID: PMC8370955 DOI: 10.1007/s10029-021-02461-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/16/2021] [Indexed: 02/05/2023]
Abstract
Purpose Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba. Methods Inclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates. Results SSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men. Conclusion Repair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02461-1.
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Affiliation(s)
- G A Dumanian
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, 675 N St. Clair, Suite 19-250, Chicago, IL, 60611, USA.
| | - S Moradian
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, 675 N St. Clair, Suite 19-250, Chicago, IL, 60611, USA
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Management of the post-pregnancy abdomen: the plastic surgical perspective. Hernia 2021; 25:929-938. [PMID: 34342744 DOI: 10.1007/s10029-021-02478-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
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Nahabedian MY. Diastasis recti repair with onlay mesh. Hernia 2021; 25:855-862. [PMID: 34331151 DOI: 10.1007/s10029-021-02464-y] [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: 04/23/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Diastasis recti represents a midline contour abnormality of the anterior abdominal wall that is secondary to attenuation of the linea alba. Severe diastasis recti is defined as attenuation of the linea alba as well as the linea semilunaris. Treatment options are variable and include conditioning exercises and surgical repair with or without mesh. This manuscript will review the indications and technique of onlay mesh for correction of severe diastasis recti. METHODS Abdominoplasty with diastasis repair has been performed in 63 women from January 2010 to January 2020. Of these, 4 had repair for severe diastasis that included plication and onlay mesh. The mesh was polypropylene in 3 patients and silk in 1 patient. Indications for onlay mesh included severe diastasis as a means of further reinforcing the strength of the anterior rectus sheath. RESULTS Of the 4 patients, all tolerated the operation well without morbidity. Natural contour was established in all. There were no infections, seromas, delayed healing or mesh removals. All drains were removed by 7 days. CONCLUSION The use of an onlay mesh has demonstrated success and should be considered in select patients for the surgical management of severe diastasis.
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Affiliation(s)
- M Y Nahabedian
- VCU College of Medicine-Inova Branch, National Center for Plastic Surgery, 7601 Lewinsville Rd # 400, McLean, VA, 22102, USA.
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Köckerling F, Lorenz R, Stechemesser B, Conze J, Kuthe A, Reinpold W, Niebuhr H, Lammers B, Zarras K, Fortelny R, Mayer F, Hoffmann H, Kukleta JF, Weyhe D. Comparison of outcomes in rectus abdominis diastasis repair-which data do we need in a hernia registry? Hernia 2021; 25:891-903. [PMID: 34319466 DOI: 10.1007/s10029-021-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rectus abdominis diastasis (RAD) ± concomitant hernia is a complex hernia entity of growing significance in everyday clinical practice. Due to a multitude of described surgical techniques, a so far missing universally accepted classification and hardly existing comparative studies, there are no clear recommendations in guidelines. Therefore, "RAD ± concomitant hernia" will be documented as a separate hernia entity in the Herniamed Registry in the future. For this purpose, an appropriate case report form will be developed on the basis of the existing literature. METHODS A systematic search of the available literature was performed in March 2021 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library. 93 publications were identified as relevant for this topic. RESULTS In total 45 different surgical techniques for the repair of RAD ± concomitant hernia were identified in the surgical literature. RAD ± concomitant hernia is predominantly repaired by plastic but also by general surgeons. Classification of RAD ± concomitant hernia is based on a proposal of the German Hernia Society and the International Endohernia Society. Surgical techniques are summarized as groups subject to certain aspects: Techniques with abdominoplasty, open techniques, mini-less-open and endoscopic sublay techniques, mini-less-open and endoscopic subcutaneous/preaponeurotic techniques and laparoscopic techniques. Additional data impacting the outcome are also recorded as is the case for other hernia entities. Despite the complexity of this topic, documentation of RAD ± concomitant hernia has not proved to be any more cumbersome than for any of the other hernia entities when using this classification. CONCLUSION Using the case report form described here, the complex hernia entity RAD ± concomitant hernia can be recorded in a registry for proper analysis of comparative treatment options.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - J Conze
- UM Hernia Center, Arabellastr. 17, 81925, München, Germany
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - W Reinpold
- Hernia Center Hamburg, Helios Mariahilf Klinik, Stader Str. 203C, 21075, Hamburg, Germany
| | - H Niebuhr
- Hanse Hernia Center, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Lammers
- Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - R Fortelny
- Medical Faculty Austria, Private Hospital Confraternitaet, Sigmund Freud Private University Vienna, 1080, Vienna, Austria
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J F Kukleta
- Klinik Im Park Zurich (Hirslanden Group), Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany
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SubCutaneous OnLay endoscopic Approach (SCOLA) for midline ventral hernias associated with diastasis recti. Hernia 2021; 25:957-962. [PMID: 34304306 DOI: 10.1007/s10029-021-02465-x] [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: 04/19/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Minimally invasive surgery for diastasis recti has gained attention in the recent past, with several reports with different names and particularities being suggested by the authors. SCOLA (Subcutaneous OnLay endoscopic Approach) is an example of this technique, described here in standardized technique. DESCRIPTION OF THE TECHNIQUE Basic steps to perform the procedure are detailed, beginning with patient and surgical team positioning, including trocar placement and tips and tricks of the subcutaneous dissection, steps needed to achieve full dissection of the preaponeurotic space, diastasis recti plication, mesh positioning and fixation and drain positioning with fixation of the umbilical stalk. DISCUSSION Regardless of different names and small technical variations, endoscopic pre-aponeurotic mesh positioning can be performed with well-established steps on a reproducible fashion, aiming to achieve better results. Careful attention should be paid to appropriate patient selection and drain placement to reduce seroma rate, the most common complication.
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Olsson A, Kiwanuka O, Sandblom G, Stackelberg O. Evaluation of functional outcomes following rectus diastasis repair-an up-to-date literature review. Hernia 2021; 25:905-914. [PMID: 34302558 PMCID: PMC8370918 DOI: 10.1007/s10029-021-02462-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. METHOD A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. RESULT Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. CONCLUSION The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.
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Affiliation(s)
- A Olsson
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - O Kiwanuka
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
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Van Vliet A, Girardot A, Bouchez J, Kumar A, Dayicioglu D. Abdominal Plication for Better Cosmetic Outcomes During Deep Inferior Epigastric Perforator Flap Breast Reconstruction. Ann Plast Surg 2021; 86:S575-S577. [PMID: 34100816 DOI: 10.1097/sap.0000000000002874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deep inferior epigastric perforator flap (DIEP) for breast reconstruction is a widely accepted technique for breast reconstruction. Secondary benefit of this technique is abdominal contour improvement. Because of direct access, abdominal plication can be performed at the time of abdominal closure. Our goal was to investigate if this addition affected the complications. METHODS A retrospective chart review was performed on all DIEP flap reconstructions performed by a single surgeon at a cancer center, from March 2011 through February 2020. Presence of abdominal plication, age, and body mass index were compared with reoperation due to abdominal wound or hernia, procedure length in minutes, and length of stay. The association between the dependent and independent variables for the unadjusted and adjusted analysis was performed using the binary logistic regression analysis. RESULTS Three hundred fifty-eight DIEP flaps performed on 233 patients for breast reconstruction were analyzed. Flap loss was 1.7%. Abdominal plication was performed in 178 flaps (49.7%) and not performed in 180 flaps (50.3%). Thirty-nine percent were immediate; 61% were delayed. The results did not show a statistically significant association between abdominal plication and the need to reoperate (P = 0.3). Results from the adjusted analysis (age, body mass index) also did not show a significant association between the plication, need to reoperate, procedure duration, or hospital stay (P = 0.4). CONCLUSIONS Abdominal plication can improve cosmetic outcomes without increasing the duration of surgery, hospital stay, or reoperation rates due to abdominal complications. Therefore, it can be a valuable addition in DIEP flap breast reconstructions.
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Affiliation(s)
- Austin Van Vliet
- From the University of South Florida Morsani College of Medicine
| | | | | | - Ambuj Kumar
- From the University of South Florida Morsani College of Medicine
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Van Kerckhoven L, Nevens T, Van De Winkel N, Miserez M, Vranckx JJ, Segers K. Treatment of rectus diastasis: should the midline always be reinforced with mesh? A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:1870-1880. [PMID: 33612425 DOI: 10.1016/j.bjps.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Two main trends are described for the treatment of diastasis recti: plication versus midline mesh reinforcement. Indications for these procedures have not been clearly described. This study reviewed the outcomes in the treatment of rectus diastasis with plication versus mesh by the assessment of durability, complications, and patient-reported outcomes. MATERIALS AND METHODS A systematic review of literature on the treatment of diastasis recti was performed searching through PubMed, Embase, Web of Science, and Cochrane databases. This resulted in 53 eligible articles and predefined inclusion criteria led to the selection of 24 articles. Primary outcomes included recurrence and perioperative complications and secondary outcomes were defined as patient satisfaction, chronic pain, and quality of life. RESULTS A total of 931 patients were surgically treated for rectus divarication (age range: 18 - 70 years). The most frequently noted comorbidity was obesity and 10.6 percent were smokers. Recurrence was reported in 5 percent of the patients. The most frequent complication was seroma (7 percent), followed by abdominal hypoesthesia (6 percent), and surgical site infection (2 percent). Chronic pain was reported in 4 percent of the patients. Satisfaction was assessed subjectively in the majority of patients and was generally rated as high. Follow-up period ranged from 3 weeks to 20 years. CONCLUSIONS Durability, safety, and high patient satisfaction support surgical correction of rectus diastasis and could not favor a treatment method. Inter-rectus distance could not be identified as the indicator for technique, which emphasizes that other factors might add to the entity of abdominal wall protrusion more than previously thought.
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Affiliation(s)
- Liza Van Kerckhoven
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Thomas Nevens
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nele Van De Winkel
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Jeroen Vranckx
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katarina Segers
- Department of Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
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Jessen ML, Öberg S, Rosenberg J. Surgical techniques for repair of abdominal rectus diastasis: a scoping review. J Plast Surg Hand Surg 2021; 55:195-201. [PMID: 33502282 DOI: 10.1080/2000656x.2021.1873794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rectus diastasis is characterized by widening and laxity of the linea alba, causing the abdominal content to bulge. Rectus diastasis is treated either conservatively with physiotherapy, or surgically, surgical treatment showing especially convincing results. The primary aim of this study was to describe surgical techniques used to correct abdominal rectus diastasis. Secondary, we wished to assess postoperative complications in relation to the various techniques. A systematic scoping review was conducted and reported according to the PRISMA-ScR statement. PubMed, Embase, and Cochrane Library were searched systematically. Studies were included if they described a surgical technique used to repair abdominal rectus diastasis, with or without concomitant ventral hernia. Secondary outcomes were recurrence rate and other complications. A total of 61 studies were included: 46 used an open approach and 15 used a laparoscopic approach for repair of the abdominal rectus diastasis. All the included studies used some sort of plication, but various technical modifications were used. The most common surgical technique was classic low abdominoplasty. The plication was done as either a single or a double layer, most commonly with permanent sutures. There were overall low recurrence rates and other complication rates after both the open and the laparoscopic techniques. We identified many techniques for repair of abdominal rectus diastasis. Recurrence rate and other complication rates were in general low. However, there is a lack of high-level evidence and it is not possible to recommend one method over another. Thus, further randomized controlled trials are needed in this area.
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Affiliation(s)
- Majken Lyhne Jessen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
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A Comprehensive, Evidence-Based Literature Review of the Surgical Treatment of Rectus Diastasis. Plast Reconstr Surg 2020; 146:1151-1164. [PMID: 33136963 DOI: 10.1097/prs.0000000000007252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy. RESULTS Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability. CONCLUSIONS Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.
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Gormley J, Copeland A, Augustine H, Axelrod C, McRae M. Impact of Rectus Diastasis Repair on Abdominal Strength and Function: A Systematic Review. Cureus 2020; 12:e12358. [PMID: 33520552 PMCID: PMC7839807 DOI: 10.7759/cureus.12358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rectus diastasis plication performed during abdominoplasty aims to narrow the widened linea alba and return the rectus muscle bellies to their anatomic position. It is unclear whether plication improves abdominal strength and function. This systematic review summarizes the effect of rectus plication on abdominal strength, function, and postoperative complications. A comprehensive search of CINAHL, Embase, Medline and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically. A total of 497 patients from seven articles were included. Mean age was 44.5 years (range 20.5-72) and 94.4% were female. Three articles reported abdominal strength measurements, with two showing significant improvement. Four articles used the SF-36 survey, all demonstrating improvement in physical function subscale postoperatively. An additional six instruments were used to assess functional outcomes, of which four demonstrated significant improvement. The overall complication rate was 17.0%. Rectus plication is commonly performed during abdominoplasty to improve abdominal form and function. While the literature to date is encouraging with respect to functional outcomes, improvements in abdominal strength are less consistent. Heterogeneity in patient population, outcome measures, and comparison groups limit the strength of our conclusions. Future research should include a large comparative study as well as a protocol for standardizing outcomes in this population.
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Affiliation(s)
- Jessica Gormley
- Plastic Surgery, Michael G. DeGroote School of Medicine, Hamilton, CAN
| | | | | | - Charlotte Axelrod
- Plastic Surgery, University of Toronto Faculty of Medicine, Toronto, CAN
| | - Mark McRae
- Plastic Surgery, McMaster University, Hamilton, CAN
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Wu L, Gu Y, Gu Y, Wang Y, Lu X, Zhu C, Lu Z, Xu H. Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: Prevalence, risk factors and its impact on life. J Clin Nurs 2020; 30:518-527. [PMID: 33207011 DOI: 10.1111/jocn.15568] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to obtain the incidence of diastasis recti abdominis (DRA) and analyse possible risk factors in adult females. Moreover, the relationships between DRA and lower back pain, pelvic floor function and quality of life were also analysed. BACKGROUND Diastasis recti abdominis is a separation of the abdominal muscles at the linea alba. Currently, studies on the prevalence rates, risk factors and consequences of DRA are varied. In particular, reports on DRA among adult women are lacking. DESIGN A one-sample questionnaire study design is used following the STROBE checklist. METHODS The inter-rectus distance was measured by computed tomography in 644 women. Custom questionnaires, the Oswestry Disability Index, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to investigate personal information, the subjects' back pain, pelvic floor function and quality of life, respectively. RESULTS The incidence of DRA was 28.4%. Age, the number of pregnancies, BMI and diabetes were influencing factors for DRA. After age stratification, pregnancy and diabetes were found to be risk factors for DRA in young women, and obesity and diabetes were risk factors for DRA in older women. This study showed that the association between DRA and low back pain was highly significant. CONCLUSIONS Diastasis recti abdominis is common in adult women. Avoiding multiple pregnancies, preventing diabetes and controlling weight may prevent DRA, which may be beneficial for decreasing low back pain in women. RELEVANCE TO CLINICAL PRACTICE The findings have important implications for the health of adult women which can provide the basis for appropriate nursing implementation for DRA patients. The application of specific prevention and intervention measures for the risk factors may reduce the severity of low back pain.
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Affiliation(s)
- Lina Wu
- School of Nursing, Wenzhou Medical University, Wenzhou, China.,Department of Nursing, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yechun Gu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Yanlan Gu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yawen Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xueqin Lu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cong Zhu
- Department of Nursing, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- School of Nursing, Wenzhou Medical University, Wenzhou, China.,Department of Emergency, The First affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongbo Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Carlstedt A, Bringman S, Egberth M, Emanuelsson P, Olsson A, Petersson U, Pålstedt J, Sandblom G, Sjödahl R, Stark B, Strigård K, Tall J, Theodorsson E. Management of Diastasis of the Rectus Abdominis Muscles: Recommendations for Swedish National Guidelines. Scand J Surg 2020; 110:452-459. [PMID: 32988320 PMCID: PMC8551433 DOI: 10.1177/1457496920961000] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. Methods: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. Results: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient’s symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. Discussion: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
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Affiliation(s)
- A Carlstedt
- Department of Surgery, Karlstad Central Hospital, Karlstad, Sweden
| | - S Bringman
- Department of Surgery, Södertälje Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Egberth
- Department of Surgery, Mora hospital, Mora, Sweden
| | - P Emanuelsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - A Olsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinic of Surgery, Capio CFTK, Stockholm, Sweden
| | - U Petersson
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - J Pålstedt
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - R Sjödahl
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - B Stark
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - J Tall
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - E Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Gluppe SB, Engh ME, Bø K. Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous. Phys Ther 2020; 100:1372-1383. [PMID: 32302393 DOI: 10.1093/ptj/pzaa070] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/29/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. METHODS In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. RESULTS Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively). CONCLUSIONS Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. IMPACT To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.
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Affiliation(s)
- Sandra B Gluppe
- Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220 Oslo 0806, Norway
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sport Medicine, Norwegian University of Sport and Physical Education, Oslo, Norway
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Barbato G, Rollo S, Maggioni C, Cianchi F, Coratti F. Laparoscopic diastasis recti abdominis and midline hernia repair. Minerva Surg 2020; 76:187-191. [PMID: 32773750 DOI: 10.23736/s2724-5691.20.08404-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diastasis recti abdominis (DRA) is defined as an abnormally wide distance separates the two rectus muscles. Thinning and widening of the linea alba is an important risk factor for development midline hernia. In patient with DRA there is an increase rate of hernia recurrence. METHODS We perform a retrospective study to assess the outcome of laparoscopic intraperitoneal hernia repair and linea alba plication combined with mesh placement to obtain an adequate overlap of midline hernia associated to an abdominal wall support. The inclusion criteria were patients who has a clinical diagnosis of primary midline hernias of any size with associated diastasis recti. The exclusion criteria were incisional hernias, hernias outside of the midline. A total of 12 patients fulfilled the inclusion criteria. No complication was observed over the follow-up period. The rates for recurrence were 0% over the follow-up period. RESULTS Despite the limited data some assumptions can be drawn from this study. The presence of DRA and coexisting hernia involves a challenging choice of the surgical treatment. Whichever approach is taken, in order to achieve an effective correction, plication of the linea alba is required. The major goal of any abdominal wall repair is not only reduction of hernia sac and prevention of further herniation but also restoration of the integrity and restitution of abdominal wall functionality. CONCLUSIONS A laparoscopic approach to midline hernias associated to DRA is feasible and reproducible. It is necessary future prospective studies on larger numbers to improve knowledge on the management of DRA.
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Affiliation(s)
- Giuseppe Barbato
- Careggi University Hospital, University of Florence, Florence, Italy -
| | - Silvia Rollo
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Cristina Maggioni
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesco Coratti
- Division of Gastrointestinal Surgery, Careggi University Hospital, Florence, Italy
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Fiori F, Ferrara F, Gobatti D, Gentile D, Stella M. Surgical treatment of diastasis recti: the importance of an overall view of the problem. Hernia 2020; 25:871-882. [PMID: 32564225 DOI: 10.1007/s10029-020-02252-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Diastasis recti (DR) is characterized by an alteration of the linea alba with increased inter-recti distance (IRD). It is more frequent in females, and when symptomatic or associated with midline hernia it needs to be surgically repaired. This retrospective study aims to demonstrate how an overall approach to DR leads to good results in terms of functional and morphological outcomes and quality of life (QoL). METHODS From January 2018 to December 2019, 94 patients were operated for DR > 50 mm, with or without midline hernias. Three different surgical approaches were used: complete laparoabdominoplasty, laparominiabdominoplasty and minimally invasive (endoscopic) technique. QoL was assessed with the EuraHS-QoL tool. RESULTS All patients were female except two males. We performed 26 endoscopic treatments (27.7%), 39 laparoabdominoplasties (41.5%) and 29 laparominiabdominoplasties (umbilical float procedure) (30.9%). The total median operative time was 160 min. No intraoperative complications were registered. In three (4.2%) cases, major surgical complications occurred, all after open operations. In 13 open surgery cases, vacuum-assisted closure (VAC) therapy was used to repair the cutaneous ischemic defect. No recurrence was registered to date. Minimally invasive surgery showed fewer complications and lower hospital stay than the open approach. The QoL was significantly improved. CONCLUSION Our experience shows the importance of an overall view of the functional and cosmetic impairment created by DR. The surgeon should obtain an optimal repair of the function, by open or minimally invasive surgery, also considering the morphological aspects, which are very important for the patients in terms of QoL.
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Affiliation(s)
- Federico Fiori
- Unit of General Surgery, Department of Surgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Via Pio II n.3, 20153, Milan, Italy
| | - Francesco Ferrara
- Unit of General Surgery, Department of Surgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Via Pio II n.3, 20153, Milan, Italy.
| | - Davide Gobatti
- Unit of General Surgery, Department of Surgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Via Pio II n.3, 20153, Milan, Italy
| | - Daniele Gentile
- Unit of General Surgery, Department of Surgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Via Pio II n.3, 20153, Milan, Italy
| | - Marco Stella
- Unit of General Surgery, Department of Surgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Via Pio II n.3, 20153, Milan, Italy
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Swedenhammar E, Strigård K, Emanuelsson P, Gunnarsson U, Stark B. Long-term follow-up after surgical repair of abdominal rectus diastasis: A Prospective Randomized Study. SCANDINAVIAN JOURNAL OF SURGERY : SJS : OFFICIAL ORGAN FOR THE FINNISH SURGICAL SOCIETY AND THE SCANDINAVIAN SURGICAL SOCIETY 2020. [PMID: 32299300 DOI: 10.1177/1457496920913677.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abdominal rectus diastasis can lead to functional disability. There is no consensus regarding treatment. This was a prospective study on patients randomized to surgery using either Quill self-retaining sutures or retromuscular mesh for abdominal rectus diastasis repair. The primary aim of the study was to compare long-term recurrence after surgery. Secondary aims were abdominal muscle strength, pain, and quality of life. METHODS A total of 57 patients were eligible and 52 were investigated. A routine 1-year follow-up ruled out any patient with recurrence and this was followed up by clinical examination for recurrence and assessment of the secondary outcomes a median of 5 years (3.8-6.5 years) after surgery. Quality of life was assessed using the Short Form-36 questionnaire. Pain related to activity was evaluated using the Ventral Hernia Pain Questionnaire. RESULTS No recurrence of abdominal rectus diastasis was found. Significant improvements were seen between index surgery and long-term follow-up in all domains of Short Form-36. There were no significant differences in quality of life or self-reported muscle strength between the two surgical groups. Long-term pain remained unchanged compared to that at the 1-year follow-up. "Pain this week" had decreased significantly at long-term follow-up compared to prior to surgery (mesh p = 0.009, Quill p = 0.003). CONCLUSIONS No recurrence of abdominal rectus diastasis appeared. There was no difference in quality of life or long-term pain between the two surgical groups. Implantation of retromuscular mesh entails more extensive surgery implying potentially higher risk for complications. This leads us to recommend reconstruction with double-row self-retaining sutures for the repair of abdominal rectus diastasis in patients with functional disability.
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Affiliation(s)
- Ebba Swedenhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), Stockholm, SE-171 76, Sweden
| | - Karin Strigård
- Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Karolinska University Hospital, Umeå, Sweden
| | - Peter Emanuelsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Gunnarsson
- Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Karolinska University Hospital, Umeå, Sweden
| | - Birgit Stark
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Swedenhammar E, Strigård K, Emanuelsson P, Gunnarsson U, Stark B. Long-term follow-up after surgical repair of abdominal rectus diastasis: a prospective randomized study. Scand J Surg 2020; 110:283-289. [PMID: 32299300 PMCID: PMC8551425 DOI: 10.1177/1457496920913677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Abdominal rectus diastasis can lead to functional disability. There is no consensus regarding treatment. This was a prospective study on patients randomized to surgery using either Quill self-retaining sutures or retromuscular mesh for abdominal rectus diastasis repair. The primary aim of the study was to compare long-term recurrence after surgery. Secondary aims were abdominal muscle strength, pain, and quality of life. Methods: A total of 57 patients were eligible and 52 were investigated. A routine 1-year follow-up ruled out any patient with recurrence and this was followed up by clinical examination for recurrence and assessment of the secondary outcomes a median of 5 years (3.8–6.5 years) after surgery. Quality of life was assessed using the Short Form-36 questionnaire. Pain related to activity was evaluated using the Ventral Hernia Pain Questionnaire. Results: No recurrence of abdominal rectus diastasis was found. Significant improvements were seen between index surgery and long-term follow-up in all domains of Short Form-36. There were no significant differences in quality of life or self-reported muscle strength between the two surgical groups. Long-term pain remained unchanged compared to that at the 1-year follow-up. “Pain this week” had decreased significantly at long-term follow-up compared to prior to surgery (mesh p = 0.009, Quill p = 0.003). Conclusions: No recurrence of abdominal rectus diastasis appeared. There was no difference in quality of life or long-term pain between the two surgical groups. Implantation of retromuscular mesh entails more extensive surgery implying potentially higher risk for complications. This leads us to recommend reconstruction with double-row self-retaining sutures for the repair of abdominal rectus diastasis in patients with functional disability.
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Affiliation(s)
- E Swedenhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Strigård
- Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Karolinska University Hospital, Umeå, Sweden
| | - P Emanuelsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - U Gunnarsson
- Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Karolinska University Hospital, Umeå, Sweden
| | - B Stark
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Henriksen NA, Kaufmann R, Simons MP, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Montgomery A. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 2020; 4:342-353. [PMID: 32207571 PMCID: PMC7093793 DOI: 10.1002/bjs5.50252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - F Berrevoet
- Department of General and Hepato-Pancreato-Biliary Surgery, Gent University Hospital, Gent, Belgium
| | - B East
- Third Department of Surgery, Motol University Hospital, Prague, Czech Republic.,First and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - R Lorenz
- Praxis 3+CHIRURGEN, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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49
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Jessen ML, Öberg S, Rosenberg J. Treatment Options for Abdominal Rectus Diastasis. Front Surg 2019; 6:65. [PMID: 31803753 PMCID: PMC6877697 DOI: 10.3389/fsurg.2019.00065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/04/2019] [Indexed: 01/24/2023] Open
Abstract
Background: Abdominal rectus diastasis is a condition where the abdominal muscles are separated by an abnormal distance due to widening of the linea alba causing the abdominal content to bulge. It is commonly acquired in pregnancies and with larger weight gains. Even though many patients suffer from the condition, treatment options are poorly investigated including the effect of physiotherapy and surgical treatment. The symptoms include pain and discomfort in the abdomen, musculoskeletal and urogynecological problems in addition to negative body image and impaired quality of life. The purpose of this review was to give an overview of treatment options for abdominal rectus diastasis. Results: The first treatment step is physiotherapy. However, evidence is lacking on which regimen to use and success rates are not stated. The next step is surgery, either open or laparoscopic, and both surgical approaches have high success rates. The surgical approach includes different plication techniques. The recurrence and complication rates are low, complications are minor, and repair improves low back pain, urinary incontinence, and quality of life. Robotic assisted surgery might become a possibility in the near future, but data are still lacking. Conclusions: Evidence on what conservatory treatment to use is sparse, and more research needs to be done. Both open and laparoscopic surgery have shown positive results. Innovative treatment by robotic assisted laparoscopic surgery has potential, however, more research needs to be done in this area as well. An international guideline for the treatment of rectus diastasis could be beneficial for patients and clinicians.
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Affiliation(s)
- Majken Lyhne Jessen
- Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract 2019; 37:1018-1033. [PMID: 31642725 DOI: 10.1080/09593985.2019.1675207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To explore the feasibility of two physiotherapy interventions for the management of diastasis recti abdominis (DrA): abdominal binding and targeting trunk exercises.Methods: A pilot randomized controlled trial (RCT) design was used to compare the effectiveness of exercise therapy and/or abdominal binding to no intervention on thirty-two primiparous women who presented with DrA in the early post-partum period. Feasibility was determined based on study recruitment, compliance, and attrition rates as well as through computation of treatment effect sizes associated with each intervention compared to no intervention. Outcomes included inter-rectus distance measured using ultrasound, body image, pain, urogynecological symptoms, and function measured using questionnaires, and trunk flexion strength and endurance measured using clinical tests.Results: The recruitment rate was 3 participants/month. Intervention adherence rates were >50% and the attrition rate was 16%. After 6 months, positive effects (Cohen's d (d) = 0.2-0.5) on body image were observed in both the abdominal binding alone and combination therapy groups. A positive effect on trunk flexion strength (d = 0.7) was observed in the combination therapy group.Conclusion: The effect sizes suggest that physiotherapy interventions can positively impact body image and trunk flexion strength. While a clinical trial investigating these interventions is feasible, further preliminary investigation is recommended.
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Affiliation(s)
- Nadia Keshwani
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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