Preliminary evaluation of surgical treatment for postpartum diastasis recti

Abstract

Abstract:

ObjectiveTo evaluate the clinical efficacy, safety and the postoperative functional improvement of the surgical treatment for postpartum diastasis recti (PDR).MethodsA retrospective study was conducted on the patients with PDR who underwent surgical treatment in Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University from November 2018 to October 2023. The patients’demography, operation data, postoperative complications, recurrence and functional evaluation before and after surgery were analyzed.ResultsA total of 39 cases were included. Open surgery was performed in 21 cases, laparoscopic surgery in 17 cases, and hybrid surgery in 1 case. On the basis of linear alba reconstruction (LAR), 26 cases were additionally repaired with Sublay mesh, 9 with Onlay, and 1 with intraperitoneal onlay mesh (IPOM); the other 3 cases were only performed with LAR. The follow-up ranged 6-45 months, and the completion rate was 92.3%. During the follow-up, no recurrence was observed, and the overall complication rate was 20.5%, including 1 case with delayed wound healing, 2 cases with seroma, and 5 cases with skin disorders in paraumbilical and subumbilical area. There were significant changes of European Registry for abdominal wall hernias quality of life (EuraHS QoL) score and Oswestry disability index (ODI) after operation, indicating significant improvement in QoL and lower back pain. The inter-recti distance(IRD) of the patients undergoing laparoscopic surgery was less than that of the patients undergoing open surgery (median 4.0 cmvs.4.5 cm), and the duration of hospital stay of the patients undergoing laparoscopic surgery was shorter than that of open surgery (median 7 daysvs.9 days).ConclusionsIn general, the surgical treatment of PDR is safe and effective, and it can not only correct the separation, but also improve QoL and lower back pain of the patients. Tailored surgical procedures should be selected for patients with different conditions.

Key words:Postpartum diastasis recti(PDR),Linear alba reconstruction(LAR),Sublay repair,Onlay repair,Quality of life (QoL)

CLC Number:

R656.3
R714

LIU Lu, ZHU Xiaoqiang, LIU Nan, LIU Jiajie, TANG Rui. Preliminary evaluation of surgical treatment for postpartum diastasis recti[J]. Journal of Surgery Concepts & Practice, 2024, 29(04): 329-335.

Figures/Tables7

Fig 1

Fig 2

Fig 3

Fig 4

Item	Preoperative	Postoperative	Zvalue	Pvalue
EuraHS QoL score	20(18-27.75)	12(8-22)	-3.529	<0.05
Pain of the side of the hernia	1(0-5)	0	-3.526	<0.01
Restrictions of activities because of pain or discomfort	2(0-16)	1(0-11)	-0.696	0.486
Cosmetic discomfort	16(10-20)	7.5(4-10)	-4.603	<0.01
ODI	7(1-12.75)	3(0-6.75)	-3.116	<0.05

Tab 1

Item	Lap（n=17）	Open（n=21）	t/Zvalue	Pvalue
BMI (kg/m²)	21.2±2.9	21.4±2.1	-0.244	0.809
Age (years)	37（32-38）	36.00（32-40）	-0.162	0.871
Operative time (min)	251±98	226±44	0.942	0.357
IRD (cm)	4.0（4.0-4.8）	4.5（4.3-6.5）	-1.985	0.047
24 h VAS	4（2-6）	3（3-5）	-0.225	0.822
48 h VAS	3（1-5）	3（1-4）	-0.665	0.506
Hospital stays (days)	7（7-8）	9（7-10）	-1.975	0.048
Cost (RMB)	39 232（37 215-42 556）	35 385（31 698-47 269）	-1.659	0.097

Tab 2

Item	Lap Sublay（n=11）	Open Sublay（n=15）	t/Zvalue	Pvalue
BMI (kg/m²)	21.7±2.8	20.8±2.2	0.916	0.369
Age (years)	36.6±5.2	36.1±6.4	-0.223	0.826
IRD (cm)	4.0（4.0-4.5）	4.5（4.5-7.0）	-2.026	0.043
Operative time (min)	280 (210-330)	220 (200-290)	-1.355	0.176
24 h VAS	3（2-4）	3（3-4）	-0.334	0.739
48 h VAS	3（1-3）	2（1-3）	-0.876	0.381
Hospital stays (days)	7（7-10）	9（7-10）	-1.413	0.158
Cost (RMB)	39 462（39 090-42 642）	35 709（33 584-47 253）	-1.583	0.113

Tab 3

References16

[1]	KÖHLER G, FISCHER I, KALTENBÖCK R, et al. Minimal invasive linea alba reconstruction for the treatment of umbilical and epigastric hernias with coexisting rectus abdominis diastasis[J].J Laparoendosc Adv Surg Tech A,2018,28(10):1223-1228. doi:10.1089/lap.2018.0018pmid:29620963
[2]	MUYSOMS F, CAMPANELLI G, CHAMPAULT G G, et al. EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair[J].Hernia,2012,16(3):239-250. doi:10.1007/s10029-012-0912-7pmid:22527930
[3]	FAIRBANK J C, PYNSENT P B. The Oswestry disability index[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[4]	RANNEY B. Diastasis recti and umbilical hernia causes, recognition and repair[J].S D J Med,1990,43(10):5-8.
[5]	REINPOLD W, KÖCKERLING F, BITTNER R, et al. Classification of rectus diastasis - a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS)[J].Front Surg,2019,6:1.
[6]	BENJAMIN D R, FRAWLEY H C, SHIELDS N, et al. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review[J].Physiotherapy,2019,105(1):24-34. doi:S0031-9406(18)30132-9pmid:30217494
[7]	GERBER P, ANDERIN C, THORELL A. Weight loss prior to bariatric surgery: an updated review of the literature[J].Scand J Surg,2015,104(1):33-39. doi:10.1177/1457496914553149pmid:25388885
[8]	王影, 张洁, 冯艳霞, 等. 电刺激治疗产后腹直肌分离的效果观察[J].中华妇幼临床医学杂志(电子版),2017,13(2):218-221.
	WANG Y, ZHANG J, FENG Y X, et al. Curative effects on electrical stimulation treatment for postpartum diastasis recti abdominis[J].Chin J Obstet Gynecol Pediatr(Electronic Edition),2017,13(2):218-221.
[9]	HAUSER R A, LACKNER J B, STEILEN-MATIAS D, et al. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain[J].Clin Med Insights Arthritis Musculoskelet Disord,2016,9:139-159.
[10]	PARKER M A, MILLAR L A, DUGAN S A. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related?[J].J Womens Health phys ther,2009,33(2):15-22.
[11]	EMANUELSSON P, GUNNARSSON U, DAHLSTRAND U, et al. Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures[J].Surgery,2016,160(5):1367-1375.
[12]	AKRAM J, MATZEN S H. Rectus abdominis diastasis[J].J Plast Surg Hand Surg,2014,48(3):163-169. doi:10.3109/2000656X.2013.859145pmid:24256310
[13]	OLSSON A, KIWANUKA O, WILHELMSSON S, et al. Cohort study of the effect of surgical repair of sympto-matic diastasis recti abdominis on abdominal trunk function and quality of life[J].BJS Open,2019,3(6):750-758.
[14]	VAN UCHELEN J H, KON M, WERKER P M. The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography[J].Plast Reconstr Surg,2001,107(6):1578-1584. doi:10.1097/00006534-200105000-00046pmid:11335840
[15]	ELHAWARY H, ABDELHAMID K, MENG F, et al. A comprehensive, evidence-based literature review of the surgical treatment of rectus diastasis[J].Plast Reconstr Surg,2020,146(5):1151-1164. doi:10.1097/PRS.0000000000007252pmid:33136963
[16]	HICKEY F, FINCH J G, KHANNA A. A systematic review on the outcomes of correction of diastasis of the recti[J].Hernia,2011,15(6):607-614. doi:10.1007/s10029-011-0839-4pmid:21688021