Surgical repair of diastasis recti abdominis provides long-term improvement of abdominal core function and quality of life: a 3-year follow-up

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.

Anatomical and Surgical Principles of Ventral Hernia Repairs

“…It has to be noted, that in many individuals, there is a laxity of the linea alba and the anterior abdominal wall myofascial complexes, which clinically can manifestate as a "bulge" during Valsalva's maneuver between the recti muscles in the epigastric region and not surpisingly DOI: http://dx.doi.org/10.5772/intechopen.102734 can be mistaken as a ventral hernia. This condition, in which only laxity of the linea alba exists without the presence of a defined, true anatomical defect exists, is called deverication of recti and its operative managment is completely different of a typical ventral hernia [15]. Therefore, the operating surgeon should have a low threshold for assesing these patients with a further imaging modality (ie ultasound, compute tomography or dynamic magnetic resonance scans) to confidently differentiate between the two conditions.…”

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“…При анализе результатов лечения ДПМЖ A. Olsson et al (2021) выявлено снижение выраженности симптомов недержания мочи после операции, что указывает на связь между восстановлением топографоанатомических соотношений передней брюшной стенки и стабилизацией мышц тазового дна [46].…”

Diastasis recti abdominis (DRA): review of risk factors, diagnostic methods, conservative and surgical treatment

“…A few months after surgery a skin fold is reduced due to scar remodelling and surgical correction of skin excess postponed to that time allows to avoid over-or under-treatment [29]. Olsson et al [30] reported no recurrences after suture plication of the linea alba and functional improvement of this surgical reconstruction persisted for 3 years. Authors describe recurrences after open plication or laxity of the abdominal wall with protrusion of linea alba, what should be interpret as recurrent DRA [3].…”

“…Although cosmetic result of a surgical intervention is of high importance, it is not yet evaluated which surgical technique has the most satisfying cosmetic outcome [3,13,30,41]. To date, despite the importance of cosmetic results, the majority (85%) of published cases are open ones [3].…”

“…The impact of surgery of quality of life has not yet been established [41]. Surgical reconstruction of DRA is safe, durable and effective, improves function and could possibly provide increased quality of life [30,31,41]. Although Kerckhoven et al [31] showed a high rate of patient satisfaction after surgical correction of DRA, they did not favour any treatment method.…”