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

Abstract

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

Efficacy of intraoperative hypertonic saline irrigation in seroma prevention after abdominal wall reconstruction procedures – a pilot cohort study

“…The other was abdominal plication in women with postpartum anterior abdominal wall insufficiency (PPAWI), whose stages include extensive dissection with separation of skin and fat flaps, abdominoplasty and implantation of a mesh in the onlay position (between the subcutaneous tissue and the fascia) 20 . We decided to distinguish between these two groups of procedures, taking into consideration the fact that the very presence of the mesh in the subcutaneous tissue may be a risk factor for seroma, as is reported in literature reviews and meta‐analyses 21,22 . However, it is worth mentioning that the above publications include comparative studies which were also carried out on old types of implants (heavy microporous ones), widely used in the past.…”

“…20 We decided to distinguish between these two groups of procedures, taking into consideration the fact that the very presence of the mesh in the subcutaneous tissue may be a risk factor for seroma, as is reported in literature reviews and meta-analyses. 21,22 However, it is worth mentioning that the above publications include comparative studies which were also carried out on old types of implants (heavy microporous ones), widely used in the past. Considering more recent and current publications, where mainly lightweight and macroporous implants are used, the prevalence of seromas is similar for onlay and sublay techniques.…”

A retrospective study of Kinesio Taping in rectus abdominis diastasis treatment and abdominal circumference improvement in postpartum women

“…This is associated with excess skin and panniculus with important repercussions on the general contour of the abdomen and its aesthetics. The trunk instability that ensues is associated with lumbar and hip pain, which is often noted after pregnancy (3)(4) .…”

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

“…Clinically, it may present as a bulging or sagging of the midline during abdominal muscle contraction and is associated with an increased risk for midline hernias 2 . RD can present in isolation but is also an important component of a postpartum general abdominal wall insufficiency 3 . Predisposing factors are pregnancy, obesity, and collagen predisposition 4 .…”

“…In approximately one-third of postpartum women the RD is persistent 7 , a prevalence that may be underestimated 8 . RD 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 9–12 A concomitant general abdominal wall insufficiency may have a greater impact on the development of severe core instability symptoms than RD alone 3 , illustrated in Fig. 1 .…”