KOGNITIF BIDAN TERHADAP PEMERIKSAAN DIASTASIS RECTI PADA IBU NIFAS

Diastasis rectus abdominis dapat terjadi kapanpun pada ibu hamil trimester dua, dampaknya pada ibu post partum yang mengalami diastasis rectus abdominis adalah melemahnya dinding abdomen, mengurangi kontraksi kekuatan otot abdomen dan kestabilan pelvis. Risiko seorang perempuan mengalami diastasis recti ini jauh lebih besar jika ukuran tubuhnya tergolong kecil, mengandung janin kembar, hamil pada usia 35 tahun ke atas, serta berat janin yang besar.Tujuan penelitian ini untuk mengetahui Hubungan kognitif terhadap pemeriksaan diastasis recti pada ibu nifas .Penelitian ini menggunakan pendekatan cross sectional . Populasi pada penelitian ini adalah seluruh tenaga kesehatan ( bidan ) di wilayah kerja UPT Puskesmas Bangsal Kabupaten Mojokerto. Sampel penelitian ini adalah sebagian tenaga kesehatan ( bidan ) yang ada di wilayah kerja UPT Puskesmas Bangsal Kabupaten Mojokerto, jumlah sampel 23 orang . pengambilan sampel pada penelitian adalah simple random sampling dilkasanakan pada bulan Agustus – November 2020. Instrumen pada penelitian menggunakan kuisioner , kemudian dianalisis secara univariat dan bivariat . untuk mengetahui hubungan menggunakan Analisis statistik Fisher’s Exact Test. Berdasarkan hasil penelitian bahwa sebagian besar responden memiliki kognitif yang baik sebanyak 13 ( 56.53 %)dan sebagian besar melakukan pemeriksaan diastasis recti sebanyak 17 ( 73.92%) responden .Berdasarkan uji Analisis Fisher's Exact Test dengan tingkat kemaknaan ( α< 0.05) didapatkan nilai (α = 0,022) menunjukkan bahwa ada hubungan kognitif dengan pemeriksaan diastasis recti pada ibu nifas .Pengetahuan didapat dari informasi sepanjang hidup seseorang. Pengetahuan tenaga kesehatan ( bidan ) tentang pemeriksaan diastasis recti yang mempengaruhi tenaga kesehatan ( bidan ) tersebut untuk melakukan pemeriksaan diastasis recti. Sebagai tenaga kesehatan seyogyanya selalu melakukan pemeriksaan diastasis recti pada ibu nifas yang datang kepelayanan baik di Rumah Sakit , Puskesmas maupun PMB

P037 TOTALLY ENDOSCOPIC SUBLAY REPAIR FOR DIASTASIS RECTI AND CONCOMITANT MIDLINE HERNIA: FIRST CASE VIDEO-REPORT

Aim We describe in detail the step by step technique of the first case of TES repair at our institution. Methods We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation. Results The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue. Conclusion Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure

O16 THE TOR-CONCEPT (TRAINING-OPERATION-REHABILITATION) APPLIED TO A COHORT OF POST-PARTUM WOMEN WITH SYMPTOMATIC DRA (DIASTASIS RECTI ABDOMINIS). EVALUATION OF PHYSICAL FUNCTION AND QUALITY OF LIFE ONE YEAR AFTER SURGERY

Aim Management of diastasis recti abdominis (DRA) differs regarding core training, surgical repair methods and post-operative rehabilitation. The purpose of this prospective cohort study was to evaluate the effect of a novel concept of treatment for DRA, the TOR-concept (Training, Operation and Rehabilitation). The concept includes preoperative evaluation of symptoms and instructed abdominal core training; tailored surgical repair of the DRA; and an individualized postoperative rehabilitation program. Material and Methods A cohort of seventy-five post-partum women with diagnosed DRA and training resistant core dysfunctions were evaluated and included to the study during 2018-2020. After surgery, all participants underwent an individualized supervised rehabilitation program with progressive increasing load for four months. Physical function was registered preoperatively and one year after surgery with the disability rating index (DRI) questionnaire. Quality of life (QoL) was assessed with the SF-36 questionnaire. The DRA and the surgical result were assessed with ultrasonography before and one year after surgery. Results Sixty-nine participants, 92%, completed the study. There were no DRA-recurrences at the 1-year follow-up. Early results shows that self-reported physical function, (DRI), improved in 88.8 % of patients, with a mean score improvement of 78.5 %. Quality of life, (SF-36), improved significantly compared with the preoperative scores, and reached a level similar to, or higher than, the normative Swedish female population. Conclusions In this cohort of post-partum women with DRA combined with core instability symptoms resistant to training, surgical reconstruction within the TOR-concept resulted in a significant improvement of physical function and QoL.

VP019 TESAR - TOTALLY ENDOSCOPIC SUBLAY ANTERIOR REPAIR - IN MIDLINE DEFECTS REPAIR

Aim In recent years, many minimally invasive techniques have been presented in abdominall wall repair. Since 2018 we have been using TESAR techinque, an anterior endoscopic approach with mesh sublay, published in 2019 from our group. Material and Methods From May 2018 to May 2021 58 Patients referred to our Unit for clinical and radiological diagnosis of ventral defect (Midline hernia, Incisional hernia, Diastasis Recti&gt;5 cm). Exclusion criteria were: maximum defeact width 8 cm, and contraindications to general anesthesia Results All the patients underwent midline repair with TESAR technique. Three TAR were performed, with defect of 8 cm width previously treated with botox. No conversion to laparotomy occured, no intraoperative complications were registered. Total mean operative time was 156 +- 21,5 min. No postoperative major complications, 3 subcoutaneous seromas occurred ,all treated conservatively. The mean Hospital stay was 2.7 + 0.8 days. Conclusions TESAR is a feasible technique for extraperitoneal repair of midline defects with a totally endoscopic approach, allowing a safe repair with good outcomes in terms of resolutions of symtoms and postoperative complications. The video shows the main steps of the technique in diastasis recti and complicated ventral hernia repair.

O42 SURGICAL REPAIR OF DIASTASIS RECTI ABDOMINIS (DRA) PROVIDES LONG-TERM IMPROVEMENT OF ABDOMINAL CORE FUNCTION AND QUALITY OF LIFE: A THREE-YEAR FOLLOW-UP

Aim Diastasis Recti Abdominis (DRA) is a condition affecting many post-partum women. The aim of this study was to evaluate long-term results of surgical repair of DRA in a cohort of post-partum women. Material and Methods Sixty post-partum women with DRA and training-resistant core dysfunctions were included. Surgical repair was performed with suture plication of the linea alba. Abdominal core function was evaluated with the Abdominal Trunk Function Protocol (ATFP) including a self-report questionnaire and seven functional tests. Urinary incontinence and Quality of Life was evaluated with the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the SF-36 questionnaire. Follow-up was performed at one year and three years’ post-operatively. Results Response rate at the three-year follow-up was 86.7 % for the DRI questionnaire; and 71.7% for ATFP, the UDI-6, IIQ-7, and SF-36 questionnaires. All DRI-parameters were improved (p &lt; 0,05) after three-years of follow-up compared to preoperative values. The functional tests in the ATFP showed an improvement (p &lt; 0.05) in core muscle strength and stability, persisting back and abdominal muscle strength compared to preoperative values as well as an improvement compared to the one-year follow-up values (p &lt; 0.05). UDI-6 and IIQ-7 results were improved (p &lt; 0.05) compared to preoperative values and showed consistent values compared to the one-year follow-up. Quality of life measured with SF-36 were improved compared to preoperative values and showed consistent values compared to the one-year follow-up (p &lt; 0.05). Conclusions The functional improvement of surgical reconstruction of the DRA persisted for three years in this series of post-partum women with DRA.

P076 DIFFERENT SURGICAL APPROACH IN DIASTASIS RECTI REPAIR: IMPORTANCE OF AN OVERALL VIEW OF THE DISEASE

Aim Diastasis Recti (DR) is characterized by a defect of the linea alba sometimes associated with midline hernias, and frequent lipocutaneous excess. We present our experience in the treatment of diastasis recti with Inter Recti Distance (IRD) &gt; 50mm -with or without umbilical hernia- by 3 different approaches. Material and Methods From January 2018 to February 2020, 104 patients were referred to our unit for clinical and radiological diagnosis of DR with IRD &gt; 50 mm. Three different surgical approaches were used, based on presence of lipocoutaneous excess: laparoabdominoplasty, laparominiabdominoplasty and minimally-invasive/endoscopic with Totally Sublay Anterior Repair (TESAR) approach. Results We performed 28 TESAR (29.8%), 44 laparoabdominoplasties (42.3%) and 32 laparominiabdominoplasties (30.8%). Overall complication rate was 26% (27 patients). In 3 (2.9%) cases major surgical complications (Clavien-Dindo 3-4) occurred, all for open operations. Minor complications (Clavien-Dindo 1-2) included: 13 cutaneous ischemia, 10 small muscular hematomas and 1 subcutaneous seroma. The overall median post-operative stay was 3 days (range 2 – 14 days), and 3, 4 and 3 days for TESAR, laparoabdominoplasty and laparominiabdominoplasty groups, respectively. No recurrence registered to date. Conclusions Our experience shows the importance of an overall view of the functional and cosmetic impairment created by the DR. The surgeon must obtain an optimal functional outcome also aiming for the best cosmetic result. Therefore different approaches have to be considered, tailored to the clinical, instrumental and psychological aspects of the disease. The complication rate, while in line with the literature, emphasize how in this type of operation the critical issues of functional as well as morphological surgery coexist.

OV05 CONCOMITANT MIRS (MINI INVASIVE RIVES STOPPA) AND DREAM (DIASTASIS REPAIR ENDOSCOPICALLY ASSISTED MINI-INVASIVE) FOR THE CORRECTION OF COMBINED VENTRAL HERNIA AND DIASTASIS RECTI

Aim Concomitant MIRS (Minimally Invasive Rives-Stoppa) and DREAM (Diastasis Repair Endoscopically Assisted Minimally-invasive) for the correction of combined ventral hernias and diastasis recti. Material and Methods The video shows the combined repair of umbilical hernia and diastasis correction by concomitant minimally invasive hernia repair without division of the posterior sheath and diastasis correction by parietoscopy. Results A short periumbilical incision is performed, the Alexis retractor is put in place, preaponeurotic dissection is carried out by direct access and two axial incisions of both anterior sheaths are performed parallel to and 1cm next to the midline. The umbilical hernia and one unexpected epigastric hernia are reduced and repaired by suture. Additional suture approximating the medial borders of anterior sheath incisions over the previous suture is performed to strengthen the repair. The patch is deployed in the retromuscular space superficial to the suture line, without any incision of the posterior sheath and without any fixation. Then the top of the Alexis retractor and the camera are put in place, insufflation at 10mm Hg is started and the parietoscopic step is carried out. Two 5mm trocars are placed and preaponeurotic dissection is extended up to the xiphoid process. The diastasis correction is carried out by a continuous suture approximating both rectus muscles from the xiphoid process to the umbilical hernia suture. Conclusions The MIRS technique consists of retromuscular patch repair without division of the posterior sheath, and concomitant DREAM technique reinforces the hernia repair and provides diastasis correction.