The Long-Term Durability of Plication of the Anterior Rectus Sheath Assessed by Ultrasonography

Uchelen, J.H. van; Kon, Masanori; Werker, Paul M. N.

doi:10.1097/00006534-200105000-00046

Cited by 75 publications

(33 citation statements)

References 14 publications

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“…In addition to contraction, several other forces could act against such a plication, i.e., intraabdominal pressure and the tissue elasticity of the linea alba and thus surgeons should respect the natural diastasis between the two rectus muscles. Regarding this issue, Birdsell et al (1981), Netscher et al (1995), al-Qattan (1997, and van Uchelen et al (2001a), found a residual or recurrent rectus diastasis from 40 to 100% in their patients after correction. Only in the three above cited studies of Nahas et al was the recurrence rate of rectus diastasis zero.…”

Section: Discussionmentioning

confidence: 93%

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The normal width of the linea alba in nulliparous women

Beer¹,

et al. 2009

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The function of the linea alba is to maintain the abdominal muscles at a certain proximity to each other. In the case of long-lasting increased intra-abdominal pressure, the linea alba widens. Yet, as the existence of the linea a priori implicates a physiological distance between the two rectus muscles, the question arises as to what the normal width of the linea alba is. To evaluate the normal width of the linea alba, we examined 150 nulliparous women between 20 and 45 years of age with a body mass index < 30 kg m(-2) by ultrasound at three reference points: the origin at the xiphoid and 3 cm above and 2 cm below the umbilicus. The examination revealed a broad range of widths at the three reference points. The linea was widest at 3 cm above the umbilicus (-35 mm), followed by the reference point 2 cm below the umbilicus (-31 mm) and the origin at the xiphoid (-31 mm). The mean width was 7 +/- 5 mm at the xiphoid and 13 +/- 7 mm above and 8 +/- 6 mm below the umbilicus. For the definition of the normal width of the linea, the 10th and 90th percentiles were taken. The linea alba can be considered "normal" up to a width of 15 mm at the xiphoid, up to 22 mm at the reference point 3 cm above the umbilicus and up to 16 mm at the reference point 2 cm below the umbilicus in nulliparous women.

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Section: Discussionmentioning

confidence: 93%

“…Van Uchelen et al (2001a) used ultrasound for the evaluation of long-term durability of plication of the anterior rectus sheath in 40 women and also considered it as a valid means of examination for assessing rectus diastasis. Recently, ultrasound has replaced computed tomography as the method of choice in examining the abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

The normal width of the linea alba in nulliparous women

Beer¹,

et al. 2009

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“…More recently, ultrasound imaging has been used to measure IRD in postpartum women 9 and women before and after abdominoplasty for postpartum DRA. 20,27 Mendes 20 demonstrated that ultrasonography is an accurate method for measuring IRD. Coldron et al 9 investigated the characteristics of DRA and concluded that ultrasound imaging is a more specific tool for measuring IRD in postpartum women; however, they did not provide specific criteria for the diagnosis of DRA.…”

Section: Ultrasound Imagingmentioning

confidence: 99%

The Relationships Between Inter-recti Distance Measured by Ultrasound Imaging and Abdominal Muscle Function in Postpartum Women: A 6-Month Follow-up Study

Liaw

Hsu²,

Liao³

et al. 2011

J Orthop Sports Phys Ther

159

113

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Diastasis recti abdominis (DRA) refers to the separation of the 2 recti abdominis muscles, and is quantified by the inter-recti distance (IRD). DRA can occur in women at the later stages of pregnancy 4,11 and remain immediately 4,8,16 and early postpartum. 4,6,9,11,16 Published case reports indicate a partial resolution of the DRA at 4 weeks, 11 8 weeks, 11 or 12 weeks postpartum. 16 Coldron et al 9 also reported that most of the recovery of IRD occurred by 8 weeks. 9 No further improvement was noted at the end of the first year, 9 suggesting that partial recovery of DRA happens after childbirth but is incomplete even after 1 year.The linea alba, separating the 2 recti abdominis, is a fibrous raphe extending from the xiphoid process to the pubic symphysis, and is formed by the interlacing aponeurotic fibers of the oblique and transverse muscles. 2,30 DRA, in pregnant women, might result from progressive stretching of the abdominal wall with T T STUDY DESIGN: A prospective longitudinal study. T T BACKGROUND: Diastasis recti abdominis(DRA) is defined as an increase in the inter-recti distance (IRD), or width of the linea alba. It is a common occurrence in women postpartum. Little information exists on the short-and long-term recovery of IRD and the relationship between changes in IRD and the functional performance of the abdominal muscles. T T OBJECTIVES:To investigate the natural recovery of IRD and abdominal muscle strength and endurance in women between 7 weeks and 6 months postpartum, and to examine the relationship between IRD and abdominal muscle function. T T METHODS:Forty postpartum (25-37 years of age) and 20 age-matched, nulliparous females participated. IRD was measured at 4 locations (upper and lower margin of the umbilical ring, and 2.5 cm above and below the umbilical ring) with a 7.5-MHz linear ultrasound transducer. Trunk flexion and rotation strength and endurance were measured with manual muscle testing and curl-ups. Evaluation was conducted at 4 to 8 weeks and 6 to 8 months after childbirth in postpartum women, and only once for the nulliparous female controls. T T RESULTS:During follow-up, the IRD at 2.5 cm above the umbilical ring and at the upper margin of the umbilical ring decreased (P = .013 and P = .002, respectively). The strength and static endurance of the abdominal muscles improved over time (P<.05). A negative correlation between IRD and abdominal muscle function at 7 weeks and 6 months postpartum was found (r = 0.34 to 0.51; P<.05, except for trunk flexion strength at 6 months postpartum [P = .064]). In addition, IRD changes between 7 weeks and 6 months postpartum were correlated with improvement in trunk flexion strength (Spearman rho = 0.38, P = .040). At 6 months after childbirth, postpartum women had greater mean  SD IRDs at all 4 locations (from cranial to caudal: 1.80  0.72, 2.13  0.65, 1.81  0.62, and 1.16  0.58 cm) than those of nulliparous females (0.85  0.26, 0.99  0.31, 0.65  0.23, and 0.43  0.17 cm) (all P<.001). All abdominal strength and endurance measurements...

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“…Moreover, other studies revealed that a suture length to wound length ratio of 4:1 (or even 6:1) decreased the incidence of incisional hernia in comparison to smaller ratios [7,16]. With respect to suture materials, studies comparing absorbable threads to nonabsorbable threads showed contradicting results [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…An objective evaluation of the results can then be achieved by using various imaging studies or by comparing complication rates [2,15,17,18].…”

Section: Discussionmentioning

confidence: 99%

Simple Continuous Suture Versus Continuous Horizontal Mattress Suture for Plication of Abdominal Fascia: Which is Better?

et al. 2012

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The Long-Term Durability of Plication of the Anterior Rectus Sheath Assessed by Ultrasonography

Cited by 75 publications

References 14 publications

The normal width of the linea alba in nulliparous women

The normal width of the linea alba in nulliparous women

The Relationships Between Inter-recti Distance Measured by Ultrasound Imaging and Abdominal Muscle Function in Postpartum Women: A 6-Month Follow-up Study

Simple Continuous Suture Versus Continuous Horizontal Mattress Suture for Plication of Abdominal Fascia: Which is Better?

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