Diastasis Recti
Diastasis recti is a condition characterized by attenuation of the linea alba and in severe cases, the linea semilunares. Multiparous women are at highest risk for developing diastasis recti because of the repetitive stretching of the anterior abdominal w
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Diastasis Recti Maurice Y. Nahabedian
41.1 Introduction
41.3 Etiology
Diastasis recti is a common condition that can manifest postpartum or following abdominal surgery. It is characterized by a widening or separation of the rectus abdominis muscles along the linea alba and in severe cases the linea semilunares as well. The differentiating feature of diastasis recti in relation to a ventral incisional hernia is that there is no fascial defect with diastasis recti. This chapter will focus on the etiology, diagnosis, and management of diastasis recti.
The etiology of diastasis recti is usually the result of increased intraabdominal pressure that is typically observed with pregnancy; however, obesity and prior abdominal operations can also cause diastasis [2]. In cases of severe diastasis recti, the myofascial laxity is both vertical and horizontal and can involve the entire anterior abdominal wall [3]. In a study of 92 patients following abdominoplasty with documented diastasis recti the inter-recti distance was measured and analyzed. It was demonstrated that the distance of rectus separation was 2 cm, no prior hernia repair or l aparotomy, and no need for abdominoplasty. The technique involves placing a trocar into the supra aponeurotic space and creating a dissection plane under direct vision exposing the linea alba and the anterior rectus sheath. The repair includes sheath plication and reinforcement with a synthetic mesh. A nonabsorbable barbed suture is typically used. A drain is placed and a soft compression garment is applied. Laparoscopic reinforcement can be
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Fig. 41.2 A preoperative photograph of a woman with severe diastasis recti and an umbilical hernia is illustrated
M.Y. Nahabedian
Fig. 41.4 Plication of the linea alba and the lateral anterior rectus sheath in vertical columns is completed using a nonabsorbable monofilament suture in two layers
Fig. 41.5 A lightweight polypropylene only mesh is applied over the anterior rectus sheath and sutured with an absorbable monofilament suture. A temporary pull-through suture is placed on the umbilicus to facilitate exteriorization during the abdominoplasty Fig. 41.3 An intraoperative image following low transverse incision and adipocutaneous elevation. The severe attenuation of the linea alba and linea semilunares is illustrated
considered in patients that have had plication of the attenuated linea alba and anterior rectus sheath. The laparoscopic placement of an intraperitoneal mesh is an alternative to onlay mesh placement [22].
41.7 Complications Complications following rectus diastasis repair are infrequent and include infection, mesh extrusion, recurrence, nerve injury, seroma, complex scar, skin necrosis, contour abnormality, and visceral injury. Patients using tobacco products are at increased risk of delayed healing and tissue necrosis [18].
In a randomized controlled trial comparing outcomes and complications in women with rectus diastasis managed with layered closure of the anterior rectus sheath or retrorectus placement of synth
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