Surgical techniques for repair of abdominal rectus diastasis: a scoping review

Jessen, Majken Lyhne; Öberg, Stina; Rosenberg, Jacob

doi:10.1080/2000656x.2021.1873794

Cited by 9 publications

(7 citation statements)

References 68 publications

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“…Therefore, the sufficiency of plicating is questioned. Jessen et al 20 performed a review of 61 studies with 3531 included patients and found a long-term recurrence rate of RD after surgery between 0% and 40%. Different plication techniques were compared but did not give a statistical significance favoring one method.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, these studies all implicate that plicating an RD can be useful. [20][21][22][23] Because we found that preoperative RD significantly increases risk of bulging, we now plicate all RDs wider than 2 cm in the UMCU. A prospective trial needs to be performed to further investigate if plicating can indeed significantly decrease the risk of abdominal bulging.…”

Section: Discussionmentioning

confidence: 99%

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Bulging after DIEP Breast Reconstruction: New Insights Concerning Rectus Diastasis and Medial Perforator Harvest

Nelissen

Krijnen

Tsehaie

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: The aim of this study was to evaluate the association between flap harvest technique and occurrence of abdominal bulging. Methods: A retrospective analysis of 159 patients undergoing DIEP flap breast reconstruction between 2014 and 2021 in the University Medical Center Utrecht was conducted. Outcomes measured were preoperative rectus diastasis, flap weight, laterality of flap harvest (unilateral or bilateral), timing of the harvest (immediate or delayed), number of perforators harvested (single or multiple), and location of the harvested perforator (medial, lateral, or both). Results: In 159 patients, 244 DIEP flaps were performed, 16 of these donor-sites (6.6%) developed a clinically evident abdominal bulge. When preoperative rectus abdominis diastasis was found (n = 97), postoperative bulging occurred significantly more often (P < 0.01). Patients in whom the medial perforator artery was harvested for reconstruction (n = 114) showed less abdominal bulging than patients in whom the lateral (n = 92) was harvested (P = 0.02). Using single versus multiple perforators for the DIEP flap, bilateral versus unilateral reconstruction or timing of the operation showed no significant difference in outcome of bulging (P = 1.00, P = 0.78, P = 0.59, respectively). Conclusions: The incidence of bulging in our study cohort is comparable to the literature. Harvesting the medial perforator artery for the DIEP flap showed less abdominal bulging than using the lateral perforator artery in a DIEP flap breast reconstruction. Also, preoperative rectus diastasis was found to be an important risk factor for the occurrence of bulging.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bulging after DIEP Breast Reconstruction: New Insights Concerning Rectus Diastasis and Medial Perforator Harvest

Nelissen

Krijnen

Tsehaie

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Plication of RD is an established component of the abdominoplasty procedure performed mainly for a cosmetic reason. In recent decades, abdominal wall surgeons have presented repair techniques with or without mesh reinforcement 30 , 31 , different open approaches 19 , 32 , and a variety of endo-laparoscopic methods as an alternative to open repairs such as endoscopic-assisted linea alba repair (ELAR), subcutaneous onlay laparoscopic approach (SCOLA), preaponeurotic endoscopic repair (REPA), total endoscopic-assisted linea alba reconstruction (TESLAR) and the robotic transabdominal retromuscular rectus diastasis (r-TARRD) repair 33–38 . Both open and endo-laparoscopic repairs have shown to be safe and effective 39 .…”

Section: Discussionmentioning

confidence: 99%

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

Olsson

Woxnerud²,

Kiwanuka

et al. 2023

BJS Open

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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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“…Several training methods have been described [ 11 ] that seem to increase core strength and stability but fail to significantly reduce the diastasis [ 12 , 13 ]. Positive results after surgical reconstruction of rectus diastasis has been reported in multiple studies [ 14 ]. A repair of the rectus diastasis is a common component in abdominoplasty, primarily performed for cosmetic reasons [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Numerous different surgical techniques for rectus diastasis repair have been described during the last decade, open as well as laparoscopic, with mesh reinforcement as well as suture repair [ 16 , 17 ]. The various surgical methods reported in the literature have been evaluated regarding recurrences and postoperative complications [ 14 ]. There is, however, a paucity of patient-reported outcomes regarding functional improvements, such as back pain, core stability, abdominal muscle strength, urinary incontinence as well as quality of life.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of functional outcomes following rectus diastasis repair—an up-to-date literature review

Olsson

Kiwanuka

Sandblom

et al. 2021

Hernia

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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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Surgical techniques for repair of abdominal rectus diastasis: a scoping review

Cited by 9 publications

References 68 publications

Bulging after DIEP Breast Reconstruction: New Insights Concerning Rectus Diastasis and Medial Perforator Harvest

Bulging after DIEP Breast Reconstruction: New Insights Concerning Rectus Diastasis and Medial Perforator Harvest

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

Evaluation of functional outcomes following rectus diastasis repair—an up-to-date literature review

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