Intra abdominal pressure changes in meshplasty and abdominal wall plication techniques in abdominoplasty: a comparative study

Background: Measurement of intra abdominal pressures is used to identify patients at risk of intra-abdominal hypertension and abdominal compartment syndrome after abdominoplasty that may lead to tight closure of the abdomen. This comparative study was aimed at measuring the IAP of patients in groups of meshplasty and abdominal wall plication, intraoperatively and post operatively.Methods: A comparative study was conducted among 34 patients who underwent meshplasty and abdominal wall plication. Each group comprised of 17 patients. All preoperative blood investigations and pre anesthetic evaluations were done. The technique used is decided based on the soft tissue laxity, rectus diastasis and presence of ventral hernias. Intra operatively, IAP was measured soon after the placement of mesh or after Rectus plication and post operatively, IAP was measured within 24 hours. IAP was measured using the intra vesical technique using Foley’s Catheter.Results: Fifty percent of the total patients were in the age group 41-50yrs and 88.2% of the patients were females. No significant variations in IAP, either intraoperative (p=0.051) or post operative (p=0.202), was evidenced in both groups. Post operatively, patient developed minimal complications such as seroma collection, wound infection and respiratory complications, improving on symptomatic treatment and antibiotics.Conclusions: No significant intraoperative or postoperative IAP was found between the two study groups underwent meshplasty and abdominal wall placation techniques.

The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study

Purpose Post-pregnancy abdominal rectus diastasis (ARD) has raised attention in the field of surgery in recent years, but there is no consensus about when to consider surgery. Our aim was to find out what is the normal inter-rectus distance in fertile aged, female population in Finland and to examine whether there is a linea alba width that would predispose to diastasis-related problems after pregnancy. Methods For this prospective cohort study, women participating early pregnancy ultrasound in Helsinki University Hospital Department of Obstetrics and Gynecology during 1.1.2018–8.3.2019, were recruited. The width of linea alba was measured by ultrasound during the early pregnancy ultrasound. Symptoms were measured by questionnaire including Health-Related Quality of Life (RAND-36) and Oswestry Disability Index for back symptoms and disability. Results Linea alba width was measured in total of 933 women. The average inter-rectus distance (IRD) among nulliparous women was 1.81 ± 0.72 cm. After one previous pregnancy, the average linea alba width was 2.36 cm ± 0.83 cm and after more pregnancies 2.55 ± 1.09 cm. There was a positive correlation between previous pregnancies and the increased linea alba width (p = 0.00004). We did not perceive any threshold value of linea alba width that would predispose to back pain or movement control problems in this cohort, in which severe diastasis (over 5 cm) was rare. Conclusion Mean inter-rectus distance in parous population exceeds stated normative values. Moderate ARD (3.0–5.0 cm) alone does not seem to explain low back pain or functional disability in population level. Severe post-pregnancy diastasis (over 5.0 cm) is rare.

Mesh abdominoplasty for rectus diastasis in women and men

Purpose Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba. Methods Inclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates. Results SSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men. Conclusion Repair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis.

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

Introduction Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. Method A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. Result Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. Conclusion The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.