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Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon’s experience

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Abstract

Background

Diastasis recti is a pathology that affects not only the abdominal wall but also the stability of lumbopelvic muscles, consequently altering urinary and digestive functionality. Preaponeurotic endoscopic repair (REPA) is an endoscopic alternative to tummy tuck for the treatment of diastasis. In this study, the outcomes of REPA application by a single surgeon are presented.

Methods

A total of 172 patients underwent REPA for the treatment of diastasis recti between August 2017 and December 2019. One hundred twenty-four patients were followed for at least one year. Sixty-three patients responded to a survey on satisfaction and quality of life 12 months after surgery.

Results

Three (2.4%) recurrences occurred, of which two occurred in the same patient. The main postoperative complications observed were 12 (9.7%) seromas, 3 (2.4%) haematomas, a single wound infection, 3 (2.4%) cases of skin fold formation, and a case of trophic skin lesion that required negative pressure therapy. Quality of life after surgery, as reported by 63 patients who responded to the survey, was satisfactory.

Conclusions

REPA is a safe and effective technique for diastasis recti treatment, representing a valid alternative to abdominoplasty. Since there is no need to access the peritoneal cavity and the mesh is onlay, there are no risks of bowel damage or adhesions between the intestine and prosthesis.

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References

  1. 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 6:1

    Article  Google Scholar 

  2. Mota P, Pascoal AG, Sancho F et al (2012) Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther 42(11):940–946

    Article  Google Scholar 

  3. Coldron Y, Stokes MJ, Newham DJ et al (2008) Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther 13(2):112–121

    Article  Google Scholar 

  4. Spitznagle TM, Leong FC, Van Dillen LR (2007) Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct 18(3):321–328

    Article  Google Scholar 

  5. Benjamin DR, van de Water ATM, Peiris CL (2014) Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 100(1):1–8

    Article  CAS  Google Scholar 

  6. Juárez Muas MD (2019) Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc 33:1777–1782

    Article  Google Scholar 

  7. Hickey F, Finch JG, Khanna A (2011) A systematic review on the outcomes of correction of diastasis of the recti. Hernia 15:607–614

    Article  CAS  Google Scholar 

  8. 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(12):4934–4949

    Article  Google Scholar 

  9. Juárez Muas DM, Verasay G, Garcia WM (2017) Reparación endoscópica prefascial de la diástasis de los rectos: descripción de una nueva técnica. Rev Hispanoam Hernia 5(2):47–51. https://doi.org/10.20960/rhh.33

    Article  Google Scholar 

  10. Pou Santonja G (Editorial) (2018) Preaponeurotic endoscopic repair’s (REPA) natural history. Rev Hispanoam Hernia. https://doi.org/https://doi.org/10.20960/rhh.145

  11. Abdalla RZ, Garcia RB, Said DF et al (2014) Quality of life of in patients submitted to anterior abdominal wall laparoscopic hernioplasty. Arq Bras Cir Dig 27(1):30–33

    Article  Google Scholar 

  12. Haxer H, von Keyserlingk DG, Prescher A (2001) Collagen fibers in linea alba and rectus sheaths. J Surg Res 96(2):239–245

    Article  Google Scholar 

  13. Naraynsingh V, Maharaj R, Dan D et al (2012) Strong linea alba: myth or reality? Med Hypotheses 78(2):291–292

    Article  CAS  Google Scholar 

  14. Blotta RM, Costa SDS, Trindade EN et al (2018) Collagen I and III in women with diastasis recti. Clinics (Sao Paulo) 7(73):e319

    Google Scholar 

  15. LeBlanc KA, Elieson MJ, Corder JM 3rd (2007) Enterotomy and mortality rates of laparoscopic incisional and ventral hernia repair: a review of the literature. JSLS 11(4):408–414

    PubMed  PubMed Central  Google Scholar 

  16. Turner PL, Park AE (2008) Laparoscopic repair of ventral incisional hernias: pros and cons. Surg Clin North Am 88(1):85–100

    Article  Google Scholar 

  17. Zhang Y, Zhou H, Chai Y et al (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38(9):2233–2240

    Article  Google Scholar 

  18. Awaiz A, Rahman F, Hossain MB et al (2015) Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 19(3):449–463

    Article  CAS  Google Scholar 

  19. Graça Neto L, Araújo LR, Rudy MR et al (2006) Intraabdominal pressure in abdominoplasty patients. Aesthetic Plast Surg 30(6):655–658

    Article  Google Scholar 

  20. 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(6):980–988

    Article  Google Scholar 

  21. Bellido LJ, Bellido LA, 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

    Article  Google Scholar 

  22. Köckerling F, Botsinis MD, Rohde C et al (2017) Endoscopic-assisted linea alba reconstruction: new technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis. Eur Surg 49:71–75

    Article  Google Scholar 

  23. Köhler G, Fischer I, Kaltenböck R et al (2018) Minimal invasive linea alba reconstruction for the treatment of umbilical and epigastric hernias with coexisting rectus abdominis diastasis. J Laparoendosc Adv Surg Tech A 28:1223–1228

    Article  Google Scholar 

  24. 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 (2018). Arq Bras Cir Dig 31:e1399

    Article  Google Scholar 

  25. Dong CT, Sreeramoju P, Pechman DM et al (2020) SubCutaneous OnLay endoscopic Approach (SCOLA) mesh repair for small midline ventral hernias with diastasis recti: an initial US experience. Surg Endosc. https://doi.org/10.1007/s00464-020-08134-x

    Article  PubMed  Google Scholar 

  26. Cuccomarino S (Editorial) (2019) Why an abdominal wall surgeon should operate a diastasis recti? Rev Hispanoam Hernia 7(2):43–46. https://doi.org/https://doi.org/10.20960/rhh.208

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Authors and Affiliations

  1. General Surgery Unit, Chivasso Hospital, Chivasso, Italy

    Salvatore Cuccomarino, Fabrizio Aprà & Alberto Jannaci

  2. Department of Surgery, University of Turin, Turin, Italy

    Luca Domenico Bonomo

  3. Department of Anesthesia and Critical Care, Città della Salute e della Scienza, Turin, Italy

    Antonio Toscano

Authors
  1. Salvatore Cuccomarino
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  2. Luca Domenico Bonomo
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  3. Fabrizio Aprà
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  4. Antonio Toscano
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  5. Alberto Jannaci
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Corresponding author

Correspondence to Luca Domenico Bonomo.

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Disclosures

Drs. Salvatore Cuccomarino, Luca Domenico Bonomo, Fabrizio Aprà, Antonio Toscano, and Alberto Jannaci have no conflict of interest or financial ties to disclose.

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All patients signed informed consent forms.

Research involving human and animal rights

This study was performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Cuccomarino, S., Bonomo, L.D., Aprà, F. et al. Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon’s experience. Surg Endosc 36, 1302–1309 (2022). https://doi.org/10.1007/s00464-021-08405-1

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  • DOI: https://doi.org/10.1007/s00464-021-08405-1

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