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Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias

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Abstract

Purpose

Rectus diastasis (RD) associated with abdominal hernias present a surgical challenge associated with a paucity in treatment guidelines. The objective of this systematic review is to review surgical techniques and assess complication and recurrence rates of RD in patients with concurrent abdominal hernias.

Methods

PubMed and EMBASE databases were systematically searched, and data extraction was performed on articles which met the inclusion criteria. Pooled analyses of complication and recurrence rates were performed to compare open vs. minimally invasive surgery. Student t tests were performed to compare differences in continuous outcomes.

Results

Twenty-eight studies were included in this review. RD can be surgically repaired by both open and laparoscopic approaches using both non-absorbable and absorbable sutures. The majority of the techniques reported included mesh insertion either above the aponeurosis, retromuscular, preperitoneal, or intraperitoneal. Open techniques, compared to laparoscopic approaches, were associated with a significantly higher rate of skin dehiscence (6.79% vs. 2.86%; p = 0.003) and hematoma formation (4.73% vs. 1.09%; p < 0.001) and a significantly lower rate of post-operative seroma formation (2.47% vs. 8.29%; p < 0.001). No significant difference in RD recurrence rates were observed between open and laparoscopic repair (0.22 vs. 0.63%, p = 0.17).

Conclusion

Both open and laparoscopic surgery are safe and effective methods that can be used to repair RD in patients with RD and concurrent abdominal hernias as evident by the low recurrence and complication rates and almost negligible major complications post repair.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada

    H. ElHawary & D. Zammit

  2. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    N. Barone

  3. Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, OH, 43212, USA

    J. E. Janis

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  1. H. ElHawary
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Dr. Janis receives royalties from both Thieme and Springer Publishing. None of the other authors have any potential conflicts of interest.

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ElHawary, H., Barone, N., Zammit, D. et al. Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias. Hernia 25, 827–853 (2021). https://doi.org/10.1007/s10029-021-02460-2

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