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).
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Brauman D (2008) Diastasis recti: clinical anatomy. Plast Reconstr Surg 122:1564–1569. https://doi.org/10.1097/PRS.0b013e3181882493
Palanivelu C, Rangarajan M, Jategaonkar PA et al (2009) Laparoscopic repair of diastasis recti using the “Venetian blinds” technique of plication with prosthetic reinforcement: a retrospective study. Hernia 13:287–292. https://doi.org/10.1007/s10029-008-0464-z
Bellido Luque J, Bellido Luque A, Valdivia J et al (2015) Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study. Hernia 19:493–501. https://doi.org/10.1007/s10029-014-1300-2
Mommers EHH, Ponten JEH, Al Omar AK et al (2017) The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options. Surg Endosc 31:4934–4949. https://doi.org/10.1007/s00464-017-5607-9
Brooks DC, Rosen M, Chen W (2018) Overview of abdominal wall hernias in adults. https://www.uptodate.com/contents/overview-of-abdominal-wall-hernias-in-adults. Accessed 7 May 2020
Reinpold W, Köckerling F, Bittner R et al (2019) Classification of rectus diastasis—a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg. https://doi.org/10.3389/fsurg.2019.00001
Beer GM, Schuster A, Seifert B et al (2009) The normal width of the linea alba in nulliparous women. Clin Anat 22:706–711. https://doi.org/10.1002/ca.20836
Ranney B (1990) Diastasis recti and umbilical hernia causes, recognition and repair. S Dak J Med 43:5–8
Sperstad JB, Tennfjord MK, Hilde G et al (2016) Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 50:1092–1096. https://doi.org/10.1136/bjsports-2016-096065
Lockwood T (1998) Rectus muscle diastasis in males: primary indication for endoscopically assisted abdominoplasty. Plast Reconstr Surg 101:1685–1691. https://doi.org/10.1097/00006534-199805000-00042
Seeras K, Qasawa RN, Prakash S (2020) Anatomy, abdomen and pelvis, anterolateral abdominal wall. StatPearls Publishing, Treasure Island
Todros S, de Cesare N, Concheri G et al (2020) Numerical modelling of abdominal wall mechanics: the role of muscular contraction and intra-abdominal pressure. J Mech Behav Biomed Mater 103:103578. https://doi.org/10.1016/j.jmbbm.2019.103578
Janis JE, Nahabedian MY, Heniford BT (2018) Introduction to “current concepts in abdominal wall reconstruction”. Plast Reconstr Surg 142:7S–8S. https://doi.org/10.1097/PRS.0000000000004832
Olsson A, Kiwanuka O, Wilhelmsson S et al (2019) Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life. BJS Open 3:750–758. https://doi.org/10.1002/bjs5.50213
Köhler G, Luketina R-R, Emmanuel K (2015) Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg 39:121–126. https://doi.org/10.1007/s00268-014-2765-y
Nahabedian MY (2018) Management strategies for diastasis recti. Semin Plast Surg 32:147–153. https://doi.org/10.1055/s-0038-1661380
Bittner R, Bain K, Bansal VK et al (2019) Update of guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)): part B. Surg Endosc 33:3511–3549. https://doi.org/10.1007/s00464-019-06908-6
Campanelli G (2020) Making complex abdominal wall hernia surgery easy. Is there a way? Hernia. https://doi.org/10.1007/s10029-020-02148-z
Baumann DP, Butler CE (2019) Diastasis recti and primary midline ventral hernia: the plastic surgery approach. Hernia 23:1017–1018. https://doi.org/10.1007/s10029-019-02055-y
Ferrara F, Fiori F, Gentile D, et al (2018) Treatment of diastasis recti abdominis with open and video-assisted approaches. In: Oral presentation at United Congress of Italian Surgical Societies. Rome, Italy
Fiori F, Ferrara F, Gentile D et al (2019) Totally endoscopic sublay anterior repair for ventral and incisional hernias. J Laparoendosc Adv Surg Tech. https://doi.org/10.1089/lap.2018.0807
Matarasso A, Matarasso DM, Matarasso EJ (2014) Abdominoplasty: classic principles and technique. Clin Plast Surg 41:655–672. https://doi.org/10.1016/j.cps.2014.07.005
Wan D, Hubbard BA, Byrd HS (2019) Achieving aesthetic results in the umbilical float mini-abdominoplasty: patient selection and surgical technique. Plast Reconstr Surg 143:722–732. https://doi.org/10.1097/PRS.0000000000005387
Muysoms F, Campanelli G, Champault GG et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall Hernia repair. Hernia 16:239–250. https://doi.org/10.1007/s10029-012-0912-7
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Hills NF, Graham RB, McLean L (2018) Comparison of trunk muscle function between women with and without diastasis recti abdominis at 1 year postpartum. Phys Ther 98:891–901. https://doi.org/10.1093/ptj/pzy083
Spitznagle TM, Leong FC, Van Dillen LR (2007) Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J 18:321–328. https://doi.org/10.1007/s00192-006-0143-5
Parker MA, Millar LA, Dugan SA (2009) Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related? J Womens Health Phys Thera 33:15–22. https://doi.org/10.1097/01274882-200933020-00003
Logan JM, Broughton G (2008) Plastic surgery: understanding abdominoplasty and liposuction. AORN J 88:603–604. https://doi.org/10.1016/j.aorn.2008.07.018
Emanuelsson P, Gunnarsson U, Dahlstrand U et al (2016) Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 160:1367–1375. https://doi.org/10.1016/j.surg.2016.05.035
Cheesborough JE, Dumanian GA (2015) Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs. Plast Reconstr Surg 135:268–276. https://doi.org/10.1097/PRS.0000000000000840
Kulacoglu H (2018) Umbilical hernia repair and pregnancy: before, during, after…. Front Surg 5:1–7. https://doi.org/10.3389/fsurg.2018.00001
Reynvoet E, Deschepper E, Rogiers X et al (2014) Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbeck’s Arch Surg 399:55–63. https://doi.org/10.1007/s00423-013-1126-x
Canziani M, Frattini F, Cavalli M et al (2009) Sutureless mesh fibrin glue incisional hernia repair. Hernia 13:625–629. https://doi.org/10.1007/s10029-009-0555-5
Baumann DP, Butler CE (2012) Bioprosthetic mesh in abdominal wall reconstruction. Semin Plast Surg 26:18–24. https://doi.org/10.1055/s-0032-1302461
Bittner R, Bain K, Bansal VK et al (2019) Update of guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—part A. Surg Endosc 33:3069–3139. https://doi.org/10.1007/s00464-019-06907-7
Lak KL, Goldblatt MI (2018) Mesh selection in abdominal wall reconstruction. Plast Reconstr Surg 142:99S–106S. https://doi.org/10.1097/PRS.0000000000004862
Campanelli G (2020) Synthetic, biologic or biosynthetic? That is the question! Hernia 24:1. https://doi.org/10.1007/s10029-020-02128-3
Reinpold W, Schröder M, Berger C et al (2019) Mini- or less-open sublay operation (MILOS). Ann Surg 269:748–755. https://doi.org/10.1097/SLA.0000000000002661
Emanuelsson P, Gunnarsson U, Strigård K, Stark B (2014) Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up. J Plast Reconstr Aesthet Surg 67:1082–1088. https://doi.org/10.1016/j.bjps.2014.04.015
Campanelli G (2019) Primary ventral hernia: where are we at? Hernia 23:829. https://doi.org/10.1007/s10029-019-02058-9
Juárez Muas DM (2019) Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc 33:1777–1782. https://doi.org/10.1007/s00464-018-6450-3
Claus CMP, Malcher F, Cavazzola LT et al (2018) Subcutaneous onlay laparoscopic approach (Scola) for ventral hernia and rectus abdominis diastasis repair: technical description and initial results. Arq Bras Cir Dig 31:e1399. https://doi.org/10.1590/0102-672020180001e1399
Timmermans L, De Goede B, Van Dijk SM et al (2014) Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg 207:980–988. https://doi.org/10.1016/j.amjsurg.2013.08.030
Huguier V, Faure J-L, Doucet C et al (2012) Couplage cœlioscopie-abdominoplastie dans dix cas d’important diastasis des grands droits. Ann Chir Plast Esthétique 57:350–355. https://doi.org/10.1016/j.anplas.2011.08.011
Neaman KC, Hansen JE (2007) Analysis of complications from abdominoplasty. Ann Plast Surg 58:292–298. https://doi.org/10.1097/01.sap.0000239806.43438.54
Momeni A, Heier M, Bannasch H, Stark GB (2009) Complications in abdominoplasty: a risk factor analysis. J Plast Reconstr Aesthet Surg 62:1250–1254. https://doi.org/10.1016/j.bjps.2008.03.043
Vastine VL, Morgan RF, Williams GS et al (1999) Wound complications of abdominoplasty in obese patients. Ann Plast Surg 42:34–39. https://doi.org/10.1097/00000637-199901000-00006
Neaman KC, Armstrong SD, Baca ME et al (2013) Outcomes of traditional cosmetic abdominoplasty in a community setting. Plast Reconstr Surg 131:403e–410e. https://doi.org/10.1097/PRS.0b013e31827c6fc3
Costa-Ferreira A, Marco R, Vásconez L, Amarante J (2016) Abdominoplasty with scarpa fascia preservation. Ann Plast Surg 76:S264–S274. https://doi.org/10.1097/SAP.0000000000000851
Winocour J, Gupta V, Ramirez JR et al (2015) Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg 136:597e–606e. https://doi.org/10.1097/PRS.0000000000001700
Mayr M, Holm C, Höfter E et al (2004) Effects of aesthetic abdominoplasty on abdominal wall perfusion: a quantitative evaluation. Plast Reconstr Surg 114:1586–1594. https://doi.org/10.1097/01.PRS.0000138757.33998.EE
Brito M, Meireles R (2020) Abdominoplasty and patient safety: the impact of body mass index and bariatric surgery on complications profile. Aesthet Plast Surg. https://doi.org/10.1007/s00266-020-01725-y
Batac J, Hamade M, Hamade H, Glickman L (2019) Abdominoplasty in the obese patient. Plast Reconstr Surg 143:721e–726e. https://doi.org/10.1097/PRS.0000000000005413
Arthurs ZM, Cuadrado D, Sohn V et al (2007) Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg 193:567–570. https://doi.org/10.1016/j.amjsurg.2007.01.006
Greco JA, Castaldo ET, Nanney LB et al (2008) The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations. Ann Plast Surg 61:235–242. https://doi.org/10.1097/SAP.0b013e318166d351
Zuelzer HB, Ratliff CR, Drake DB (2010) Complications of abdominal contouring surgery in obese patients. Ann Plast Surg. https://doi.org/10.1097/SAP.0b013e3181cf9f9e
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
The procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Formal informed consent was obtained from all patients.
All patients provided informed consent.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Fiori, F., Ferrara, F., Gobatti, D. et al. Surgical treatment of diastasis recti: the importance of an overall view of the problem. Hernia 25, 871–882 (2021). https://doi.org/10.1007/s10029-020-02252-0
- Diastasis recti
- Minimally invasive
- Abdominal wall