A new minimally invasive technique for the repair of diastasis recti: a pilot study

Abstract

Background Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. Methods It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. Results Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. Conclusions This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

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

“…The review of current literature identified 264 studies, of which 10 studies met the inclusion criteria [19][20][21][22][23][24][25][26][27][28], Fig. 1.…”

“…1. The reports fulfilling these criteria included two randomized controlled studies (RCTs) [21,28] and eight prospective cohort studies [19,20,[22][23][24][25][26][27].…”

“…Manetti et al [ 22 ], from the Department of General Surgery at St. Giovanni Addolorata Hospital in Rome Italy, reported a series of laparoscopic repairs in a prospective cohort study in 2021. Seventy-four patients with diagnosed rectus diastasis (> 2 cm) combined with associated symptoms, were included and underwent laparoscopic surgery with a stapler closure of the anterior rectus sheets combined with a retromuscular mesh.…”

“…Five of the prospective cohort studies on open repair used absorbable sutures in one case [ 23 ] and non-absorbable sutures in three cases [ 24 , 25 , 27 ], while one study did not report data on suture material [ 26 ]. Three studies analysed laparoscopic repairs, one used stapling closure of the anterior rectus sheets combined with sublay mesh reinforcement [ 20 ]; one used stapling closure of the posterior rectus sheets combined with sublay mesh reinforcement [ 22 ]; and the third used suture repair of the anterior rectus sheets combined with onlay mesh reinforcement [ 19 ], Table 2 .…”

“…Four studies reported changes in lung function perioperatively [ 24 ], early postoperatively [ 25 ], 6 months after surgery [ 22 ] and at 1-year follow-up. [ 28 ] Pereira et al reported a significant decrease of perioperative pulmonary compliance (P-Comp) measured before and after plication of the rectus diastasis, pre-plication score 38.98, and post-plication score 36.54 ( p = 0.0076) [ 24 ].…”