Laparoscopic retromuscular hernia repair (LaHRR): a case-series of 17 patients treated with a novel technique for laparoscopic ventral hernia and diastasis repair.

INTRODUCTION: Many minimally invasive techniques have been developed over the years to treat primary ventral hernias and rectus abdominis diastasis, all of which have their advantages and disadvantages in terms of complications, reproducibility, and cost. We present a case-series of a novel approach that was safe and reproducible in a cohort of 17 patients. PATIENTS AND METHODS: All patients in the study underwent the novel procedure between October 2022 and July 2023. We collected data retrospectively, including patient general characteristics, surgical outcomes, and complications. Patient follow-up lasted 12 months to exclude recurrences. RESULTS: Seventeen patients underwent the procedure for primary uncomplicated ventral hernias and rectus diastasis. The median length of hospital stay was 2 days (IQR 2-3). In 4 out of 17 cases minor complications occurred within 30 days, of which 3 were class I and 1 was a class II complication according to the Clavien-Dindo classification. There were no recurrences. CONCLUSION: Although limited by a small cohort of patients and a non-comparative study design, our study presents encouraging results in regards to the safety of this technique. More studies with a larger study population are needed to evaluate the benefits and pitfalls of this new technique.[query names].

Endoscopic-assisted repair of combined ventral hernias and diastasis recti: minimizing seroma incidence by quilting.

BACKGROUND: To reduce the incidence of seromas, we have adapted the quilting procedure used in open abdominoplasty to the endoscopic-assisted repair of concomitant ventral hernia (VH) and diastasis recti (DR). The aim of this study was to describe the technique and assess its efficacy by comparing two groups of patients operated on with the same repair technique before and after introducing the quilting. METHODS: This retrospective study included data prospectively registered in the French Club Hernie database from 176 consecutive patients who underwent surgery for concomitant VH and DR via the double-layer suturing technique. Patients were categorized into two groups: Group 1 comprised 102 patients operated before introducing the quilting procedure and Group 2 comprised 74 operated after introducing the quilting. To carry out comparisons between groups, seromas were classified into two types: type A included spontaneously resorbable seromas and seromas drained by a single puncture and type B included seromas requiring two or more punctures and complicated cases requiring reoperation. RESULTS: The global percentage of seromas was 24.4%. The percentage of seromas of any type was greater in Group 1 (27.5%) than in Group 2 (20.3%). The percentage of Type B seromas was greater in Group 1 (19.6%) than in Group 2 (5.4%), when the percentage of Type A seromas was greater in Group 2 (14.9) than in Group 1 (7.9%). Differences were significant (p = 0.014). The operation duration was longer in Group 2 (83.9 min) than in Group 1 (69.9 min). Four complications requiring reoperation were observed in Group 1: three persistent seromas requiring surgical drainage under general anesthesia and one encapsulated seroma. CONCLUSION: Adapting the quilting technique to the endoscopic-assisted bilayer suturing technique for combined VH and DR repair can significantly reduce the incidence and severity of postoperative seromas.

Robotic-assisted endoscopic onlay repair (R-ENDOR) for concomitant ventral hernias and diastasis recti: initial results and surgical technique.

BACKGROUND: The surgical management of midline ventral hernias complicated by concomitant diastasis recti presents a significant clinical challenge. The Endoscopic Onlay Repair (ENDOR) offers a minimally invasive solution, effectively addressing both conditions. This study focuses on describing the adaptation of ENDOR to a robotic platform, termed R-ENDOR, aiming to report initial outcomes along with other established robotic surgical approaches. METHODS: This retrospective case series study included consecutive adult patients who underwent R-ENDOR approach from October 2018 to April 2023, performed by a single surgeon. A comprehensive description of the surgical technique is included. Patient demographics, operative, and hernia-specific characteristics, as well as clinical outcomes are described. RESULTS: A total of 15 patients undergoing R-ENDOR for ventral hernia repair with diastasis recti plication were included. The median age was 59 years (IQR 42-63), with 60% (n = 9) female patients. The majority (86%, n = 13) had an ASA score of ≤ 2, and the median BMI was 24 kg/m2, with 20% (n = 3) classified as obese. Median hernia size was 2 cm (IQR 2-2.25), with a median diastasis length of 19 cm (IQR 15-21.5) and width of 4 cm (IQR 3-6). The median operative time was 129 min (IQR 113-166). Most repairs (93%, n = 14) were reinforced with mesh, predominantly self-fixating (73.3%, n = 11). Eighty percent of patients (n = 12) were discharged on the same day, with a median follow-up of 153 days (IQR 55-309). Notable complications included clinically significant seromas in 20% of patients (n = 3), long-term hypoesthesia in 40% (n = 6), and readmission in one patient (6.6%) for surgical site infection (SSI) requiring IV antibiotic therapy. CONCLUSION: Midline ventral hernias associated to diastasis recti can be managed robotically by ENDOR with safe and consistent 90-day outcomes in a carefully selected group of patients.

Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice.

INTRODUCTION AND HYPOTHESIS: Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. METHODS: For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. RESULTS: Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. CONCLUSIONS: Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.

Long-Term Outcomes of Diastasis Recti Abdominis in Postpartum Women: A Retrospective Cohort Study.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate whether diastasis recti abdominis (DRA) can cause adverse outcomes for different long-term postpartum women. METHODS: We recruited 437 long-term postpartum women at five different time points (3, 5, 10, 20, and 30 years postpartum respectively). Inter-recti distance (IRD) and linea alba or umbilical hernia were measured by ultrasound. Strength of abdominal muscle was measured by a manual muscle test. Low back pain (LBP), urinary incontinence (UI) and quality of life (QOL) were measured by questionnaires including the Oswestry Disability Index, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, 36-Item Short Form Health Survey respectively. RESULTS: Women with DRA experienced more severe LBP, and poorer QOL only 10 years postpartum according to the diagnostic criterion of IRD > 2cm. However, when the diagnostic criterion was raised to IRD > 3cm, women with DRA reported weaker abdominal muscle strength, more severe LBP 3, 5, and 10 years postpartum, poorer QOL 3, 5, 10, and 20 years postpartum, and higher incidence of linea alba or umbilical hernia 5 and 20 years postpartum. CONCLUSIONS: When using IRD > 2cm as the diagnostic criterion, the impact of DRA is minimal. However, when utilizing IRD > 3cm as the diagnostic criterion, DRA is associated with increased linea alba or umbilical hernia, weakened abdominal muscle strength, increased LBP, and decreased QOL. Most of the effects are particularly evident within 3-10 years postpartum, but becomes insignificant 20 and 30 years postpartum. Therefore, it is necessary to consider whether the diagnostic criterion of DRA need to be improved.

Mothers' experiences living with diastasis recti abdominis - an interview study.

BACKGROUND: Diastasis recti abdominis (DRA) is a common postpartum condition. Knowledge is scarce on how mothers perceive living with DRA. The interaction between healthcare providers and patients plays a significant role in shaping the healthcare service experience. Women suffering from typical women's diseases tend to experience not being taken seriously or listened to when seeking healthcare. The aim of this study was to explore mothers' experiences living with DRA. METHODS: Semi-structured individual interviews were conducted with six Norwegian mothers, age 32-41, presenting with a clinically significant DRA. Topics discussed were how the condition is experienced, how it affects different aspects of day-to-day life and experiences with healthcare services. The data was analyzed using systematic text condensation. RESULTS: DRA had an impact on everyday life among the mothers included in this study. Three major themes emerged: (I) The path to obtaining knowledge and understanding of DRA, (II) DRA - intertwined with health issues and physical limitations and (III) A changed belly - on self-image & social interactions. The mothers experienced uncertainties and frustration when trying to learn about DRA. The limited knowledge of the condition made it hard to differentiate if the experienced symptoms were caused by presence of DRA or from other health issues. Several mothers felt misunderstood. CONCLUSION: DRA is a multifaceted condition affecting many aspects of day-to-day life in various dimensions, like physical, emotional, and social. This study contributes to a wider understanding of living with DRA, which might guide healthcare professionals in providing support for mothers with this condition.

Multidimensional Ultrasound Evaluation of Diastasis Recti Abdominis During Different Gestational Periods.

OBJECTIVE: The purpose of this study is to explore the application value of two-dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of diastasis recti abdominis (DRA) during different gestational periods. METHODS: A cohort of 202 gravidas that were examined in our hospital between June 2021 and September 2022 were selected for the purpose of the study, which included 26 cases with <14 weeks of pregnancy, 36 cases in the 14th-27th week of pregnancy, 36 cases in the 28th-34th week of pregnancy, 32 cases in the 35th-38th week of pregnancy, 45 cases at 42 days postpartum, and 27 cases at 3 months postpartum. The inter-rectus distance (IRD) and the thickness in each gestational period were measured, and Young's modulus of the rectus abdominis at different gestational periods was measured using SWE by two sonographers. The differences in IRD, thickness, and elasticity characteristics during different periods, and the correlation between rectus abdominis elasticity and IRD, thickness, body mass index (BMI), neonatal weight, and delivery mode were analyzed and compared. The consistency of SWE parameters obtained by different sonographers was also compared. RESULTS: There were significant differences in IRD, thickness, and Young's modulus during different gestational periods (P = .000, P < .001, P < .001). Early postpartum IRD and Young's modulus did not restore to the level of early pregnancy (P < .001, P < .001), while the thickness of rectus abdominis was not significantly different from that of early pregnancy (P = .211). The Young's modulus of rectus abdominis was negatively correlated with the IRD (r = .515), positively correlated with the thickness of rectus abdominis (r = .408), and weakly negatively correlated with maternal BMI (r = -.296). There was no significant correlation with neonatal weight or delivery mode (P = .147, .648). The Bland-Altman plot showed that the two sonographers had good consistency in evaluating the elasticity of rectus abdominis by SWE. CONCLUSION: The multidimensional evaluation of DRA by ultrasound is feasible and IRD and Young's modulus can be used to evaluate the postpartum recovery of DRA. The combination of the two can objectively reflect the severity of DRA morphology and function.

Diastasis Recti Abdominis: A Practical and Effective Width-Length Classification Based on Ultrasound Measurements and its Clinical Validation.

OBJECTIVES: This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility. METHODS: We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment. RESULTS: The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%. CONCLUSIONS: This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.

Intra- and Interimage Reliability of Inter-Rectus Distance Measurements Determined via Ultrasound Imaging by the Same or Different Testers in Women in the Early Postpartum Period.

OBJECTIVES: No consensus regarding the optimal position and location for the measurement of the inter-rectus distance (IRD) via ultrasound (US) has been reached. By investigating the intra- and interimage reliability of IRD measurements taken in different positions and at different locations within and between testers, this study provides a theoretical basis for the current situation. METHODS: The IRD was measured via US in 46 women at 42-60 days after delivery at the superior margin of the umbilicus and 3 cm above, 5 cm above and 3 cm below the umbilicus while the women were in the supine, crunch and standing positions. In the interimage test, every participant was tested 2 times by Physician X and 1 time by Physician Y; in the intraimage test, the images collected by Physician X during the first test were saved in the machines, and two measurements were performed by Physician X and one measurement was performed by Physician Y. Paired t tests and intraclass correlation coefficients (ICCs) were calculated. RESULTS: Only the first IRD measurements by tester X and tester Y at 3 cm below the umbilicus in the crunch position were significantly different (9.56 ± 6.00 versus 11.00 ± 5.55) (P < .05). All the ICCs were greater than .75, and the intratester ICCs were greater than or equal to the corresponding intertester ICCs. The ICCs at 3 cm below the umbilicus were the smallest in the supine and crunch positions and the largest in the standing position due to the increased frequency of IRD values of 0. The ICCs for the crunch position were greatest according to the intraimage test but smallest according to the interimage test. The interimage ICCs between the two testers in the supine position at the superior margin, 3 cm above, 5 cm above, and 3 cm below the umbilicus were .972, .974, .975, and .956, respectively. CONCLUSIONS: Ultrasound imaging (USI) is a reliable method for measuring the IRD in women in the early postpartum period. The dynamic measurement of the IRD at or above the umbilicus in the supine position by different testers in real time showed the highest reliability.

Radiographic calibration for pubic diastasis assessment in bladder exstrophy-epispadias complex: a phantom study.

BACKGROUND: The assessment of pubic diastasis is important for the surgical planning of patients with bladder exstrophy-epispadias complex. Understanding how the diastasis changes during surgical follow-up may help predict patient morbidity. Radiography can follow diastasis but may be affected by patient and technical imaging factors including body size, imaging protocol, and equipment. Using imaging calibration and anatomic ratios may mitigate differences due to these aspects. OBJECTIVE: Use imaging phantoms to assess the effect of radiographic calibration on measurements of pubic diastasis and an internal anatomic ratio as a child grows. MATERIALS AND METHODS: Radiographic images were obtained of three different sizes of computed tomography phantoms (older child, child, and infant) using three imaging techniques that include the osseous pelvis in children. All phantoms were imaged with abdomen and pelvis techniques. The infant phantom was additionally imaged using a thoracoabdominal technique. These exposures were all repeated with systems from three manufacturers. Linear measurements were made between radiographic markers placed to simulate pubic diastasis and sacral width. A ratio was also created between these distances. Measurements with and without image calibration were made by two pediatric radiologists using rulers placed at the time of image acquisition. RESULTS: There was excellent interrater agreement for measurements, ICC >0.99. Anterior distances were more affected by magnification than posterior ones with a significant difference between uncalibrated versus calibrated anterior distances (p=0.04) and not for posterior ones (p=0.65). There was no difference between radiographic equipment manufacturers without or with calibration (p values 0.66 to 0.99). There was a significant difference in simulated pubic distance between thoracoabdominal and abdomen (p=0.04) as well as pelvic (p=0.04) techniques which resolved with calibration, each p=0.6. The ratio between the simulated pubic diastasis and sacral width differed by phantom size (all p<0.01) and imaging technique (p values 0.01 to 0.03) with or without calibration. However, the numerical differences may not be clinically significant. CONCLUSION: Image calibration results in more uniform measurements that are more accurate than uncalibrated ones across patient size, imaging techniques, and equipment. Image calibration is necessary for accurate measurement of inter-pubic distances on all projection imaging. Small differences in the pelvic ratio likely are not clinically significant, but until there is a better understanding, image calibration may be prudent.

Standardization of the Extent and Timing of Rectus Diastasis Repair in Abdominoplasty Cases with TOF Neuromuscular Monitoring: A Clinical Study.

Despite the close focus on the anterior abdominal wall and the classification, maneuvers and materials related to the rectus abdominis and its fascia, there is no established standard concerning the extent of plication. The anterior abdominal wall is a musculoaponeurotic structure and a dynamic motor system with innervation and tonus. Therefore, the timing of the plication is as important as the suture technique and material, since the muscle relaxant will lose its effect in varying time periods. The aims of our study were to determine the change in the amount of plication between groups with and without muscle relaxants before plication and whether the amount of this change can be standardized using train-of-four (TOF) monitoring. In 2022 and 2023, 12 women aged between 25 and 48 years with a body mass index between 24 and 38 years were included in the study. Neuromuscular blockade was monitored by train-of-four (TOF) monitoring in all patients. Maximum plication areas at above-zero TOF value and zero TOF value were calculated and compared with each other. The reduction in the area of group 1, which represents the phase without muscle relaxant, and group 2, which represents the phase with neuromuscular blockade, were compared using the t-test. When assessed for above-zero TOF, the area between plication lines (a, a') was always smaller than the area between the plication lines (b, b') when the TOF value was zero. The t test comparison of group 1, which includes (a, a') values, and group 2, which includes (b, b') values, resulted in a value of p = 0.000. All cases, the plication value obtained with above-zero TOF value was lower than the plication value when the TOF value was zero. This difference was also confirmed statistically on a group basis. This suggests that neuromuscular measurements should be taken during the plication phase in the routine flow of surgery. Muscle relaxants are not routinely administered to patients undergoing abdominoplasty or rectus diastasis repair who are already under sufficient analgesia, unless there is a pressure alert on the anesthesia device. The surgeon cannot always determine the degree of muscle laxity accurately by palpation. TOF monitoring is a cost-effective quantitative method that can be easily and quickly performed, accurately determining the timing of muscle-fascia plication of the rectus abdominis. Through this approach, the anterior abdominal wall can be plicated with maximum tightness and maximum aesthetic gain can be obtained.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The "Scarless Ab-Lift": A Novel Method for the Treatment of Skin Laxity with Rectus Muscle Diastasis.

BACKGROUND: Pregnancy and vaginal delivery result in irreversible damage to the abdominal wall and skin. In the article, we present a new method for treating major skin laxity, rectus muscle diastasis, and umbilical hernia. METHODS: A 38-year-old woman with rectus muscle diastasis, umbilical hernia, and major skin laxity was treated with the scarless ab-lift procedure. The extent of diastasis before the surgery, on day 5 after surgery, and 3 months after surgery were measured. Skin laxity was evaluated 5 days and 3 months after surgery. RESULTS: The rectus muscle diastasis was restored on day 5 after surgery and remained unchanged 3 months later. Only minor supraumbilical folding was visible on day 5, and this disappeared after 3 months. The patient had only mild postoperative pain on day 5, and peroral non-steroid anti-inflammatory analgesics provided sufficient relief. Three months after surgery, she was without pain. No sensory defects were noted on the mobilized skin, and no seroma developed. CONCLUSION: The scarless ab-lift is a minimally invasive method that completely restores the abdominal wall and skin integrity in patients with rectus muscle diastasis and skin laxity after pregnancy. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of dorsoplantar miniscrew fixation of the second metatarsal base fracture on residual diastases in acute lisfranc fracture-dislocation.

PURPOSE: This study aimed to evaluate and compare the clinico-radiographic outcomes between two techniques for acute Lisfranc fracture-dislocation with a large, displaced second metatarsal base plantar fracture: isolated Lisfranc screw fixation versus Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base. METHODS: We retrospectively compared the clinico-radiographic outcome between patients who underwent isolated Lisfranc screw fixation (Group 1, 26 patients) and those who underwent Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base (Group 2, 23 patients). The main outcome measurements were the postoperative distance between the medial cuneiform and second metatarsal base on standing anteroposterior foot radiographs, known as the C1-M2 distance. Residual diastasis was defined as C1-M2 distance ≥ 2 mm on the affected side compared with that on the contralateral side. We also assessed the Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and sports subscale scores at three, six and ≥ 18 months postoperatively. RESULTS: At the final follow-up, the mean C1-M2 distance on the affected side compared with that on the contralateral side was significantly greater in Group 1 than in Group 2 (3.9 versus 0.7 mm, P = 0.027). Furthermore, Group 1 showed a higher incidence of residual diastases at the final follow-up (69.2%) than the Group 2 (13.0%, P < 0.001). The FAAM-ADL scores at the final follow-up did not differ significantly between the groups (P = 0.518), but the FAAM Sports score was significantly higher in Group 2 than in Group 1 (P = 0.001). CONCLUSIONS: The postoperative C1-M2 distance was better maintained with Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base than with isolated Lisfranc screw fixation. We recommend that surgeons exercise caution when dealing with a second metatarsal plantar fracture and consider performing secure fixation using the dorsoplantar miniscrew technique for improved clinical outcomes.

Could Abdominoplasty with Diastasis Recti Abdominis Correction Improve Stress Urinary Symptoms? A 1-Year Follow-up Prospective Study.

BACKGROUND: Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms. MATERIALS AND METHODS: This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery. RESULTS: The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire. CONCLUSION: The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Relationship between Abdominal Diastasis and Lumbar Pain Pressure Threshold in Women Who Have Given Birth between the Ages of 30 and 45 Years-An Observational Pilot Study.

Background and Objectives: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. Material and Methods: This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. Results: There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. Conclusions: there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.

Prevalence of diastasis m. rectus abdominis and pelvic floor muscle dysfunction in postpartum women.

OBJECTIVE: The aim of this study was to determine the prevalence of Diastasis of the rectus abdominis muscles (DRAM) and pelvic floor muscle dysfunction (PFMD) in postpartum women. Design: The observational prospective study. MATERIAL: 150 of 180 women (83.3 %) from 6 weeks to 6 months postpartum, with a mean age of 33.1 years. METHODS: For diastasis examination, inter recti distance (IRD) was measured by a linear 2D ultrasound probe, 4.5 cm above the navel, in its area and 4.5 cm below the navel when lying on the back at rest and under a load test. The degree of DRAM was classified into four grades. Urinary leakage symptoms were assessed by the International Incontinence Consultation Questionnaire (ICIQ - UI SF). RESULTS: The first degree of diastasis during the load test was 38.1 % above the navel, 36.4 % in the navel area, and 23.7 % below the navel. The second degree of diastasis with load was 28.8 % above the navel, 21.2 % in the navel area, and 10.2 % below the navel. PFMD showed 31.3 % of women with mild symptoms of SUI, 32.2 % of women with grade 1 cystocele. CONCLUSION: The average IRD distance at rest and during the load test confirmed the first grade of DRAM out of four degrees of severity. Moderate and medium DRAM occurred according to location in an average of one-third of the cases. The highest percentage of DRAM was above the navel, and the lowest percentage below the navel. PFMD was detected in an average of one-third of cases. It is important to monitor these parameters with a view to improving the quality of life index in the future (Tab. 5, Ref. 22).

Incisura tangent method to determine the transsyndesmotic axis for syndesmotic fixation.

BACKGROUND: Clamping along the transsyndesmotic (TS) axis decreases the risk of malreduction when reducing syndesmotic diastasis. We aimed to measure the difference between the TS axis and the axis determined by the newly proposed fluoroscopic incisura tangent (IT) method. The measurements were compared to those between the TS axis and those based on the center-center (CC) and talar dome lateral (TL) methods. METHODS: We analyzed computed tomographic images of 43 normal ankles. The IT view was simulated using a digitally reconstructed radiograph, in which the anterior and posterior fibular incisura tubercles overlapped on the internally rotated anteroposterior view. The interaxis angle between the TS and the axes determined by the IT method was measured on the axial computed tomographic image corresponding to the radiographic image. The same procedure was repeated using the CC and TL methods. The measured values were compared between the three methods using a one-factor analysis of variance. Furthermore, the measurements of the anteverted and retroverted incisurae were compared for each fluoroscopic method. RESULTS: The mean interaxis angles between the TS were - 0.5 degrees, 6.3 degrees, and - 1.8 degrees for the IT, CC, and TL methods, respectively, with a significantly larger value for the CC method than for the IT and TL methods (P < .001). No significant difference was found in the interaxis angle in the anteverted (-0.1 degrees) and retroverted (-1.0 degrees) incisurae when using the IT method (P = .15). The angles in the retroverted incisurae were larger than those of the anteverted incisurae for the CC and TL methods. CONCLUSION: The fluoroscopic IT method accurately estimated the TS axis. The interaxis angles were consistent, regardless of the incisura anatomy. The fluoroscopic method can be used to clamp and fix the syndesmosis along the TS axis. LEVEL OF EVIDENCE: Ⅳ.

Comparative analysis of the efficacy and functionality of abdominoplasty versus minimally invasive techniques in the surgical treatment of diastasis rectus abdominis in postpartum women.

INTRODUCTION: This review aims to describe the surgical options available for treatment of diastasis recti in postpartum women, as well as compare the effectiveness of these treatment options. Historically, diastasis recti has been repaired through open procedures, such as abdominoplasty. More recently, studies have explored other methods for the treatment of diastasis recti, including various minimally invasive surgical options. METHODS: Twelve studies ranging from 2015 to 2022 were included in this analysis. Studies were identified using PubMed, EMBASE, and Cochrane Library. Studies that met the inclusion criteria were analyzed descriptively. Statistical comparison of surgical outcomes between studies was performed using Fisher's Exact Test in SPSS. RESULTS: Minimally invasive approaches were categorized as laparoscopic preaponeurotic approaches, robotic approaches, and enhanced-view/extended totally extraperitoneal (eTEP) approaches. These techniques were compared to two open approaches: abdominoplasty and miniabdominoplasty. There were no significant differences in the rate of seromas, surgical site infections/complications, or hematomas between abdominoplasty and minimally invasive surgical techniques (p > 0.05). Among the minimally invasive techniques, no significant differences in readmission rates were reported (p > 0.05). Additionally, no significant differences in recurrence rates were seen following minimally invasive or abdominoplasty repairs, except for the increased recurrence rates seen with the r-TARRD robotic technique (p < 0.05). CONCLUSION: Although current data on minimally invasive approaches is limited, our review reveals that both open and minimally invasive approaches are viable options for diastasis recti repair in postpartum women. Identifying the optimal approach for diastasis recti repair should rely on the patient's desired treatment outcome. If the patient indicates a desire for the removal of excess abdominal subcutaneous tissue, abdominoplasty may be a better surgical approach. Alternatively, if the patient puts a greater emphasis on shorter recovery time and smaller surgical incisions/scars, minimally invasive approaches may be a better surgical option.

Minimally invasive bilayer suturing technique for the repair of concomitant ventral hernias and diastasis recti.

BACKGROUND: According to EHS guidelines, mesh repair is recommended in case of concomitant diastasis recti (DR) and ventral hernia more than 1 cm in diameter. Since in this situation, the higher risk of hernia recurrence may be attributed to the weakness of aponeurotic layers, in our current practice, for hernias up to 3 cm, we use a bilayer suture technique. The study aimed at describing our surgical technique and evaluating the results of our current practice. METHODS: The technique combines suturing repair of the hernia orifice and diastasis correction by suture, and includes an open step through periumbilical incision and an endoscopic step. The study is an observational report on 77 cases of concomitant ventral hernias and DR. RESULTS: The median diameter of the hernia orifice was 1.5 cm (0.8-3). The median inter-rectus distance was 60 mm (30-120) at rest and 38 mm (10-85) at leg raise at tape measurement and 43 mm (25-92) and 35 mm (25-85) at CT scan respectively. Postoperative complications involved 22 seromas (28.6%), 1 hematoma (1.3%) and 1 early diastasis recurrence (1.3%). At mid-term evaluation, with 19 (12-33) months follow-up, 75 (97.4%) patients were evaluated. There were no hernia recurrences and 2 (2.6%) diastasis recurrences. The patients rated the result of their operation as excellent or good in 92% and 80% of the cases at global and esthetic evaluations, respectively. The result was rated bad at esthetic evaluation in 20% of the cases because the skin appearance was flawed, due to discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer. CONCLUSION: The technique provides effective repair of concomitant diastasis and ventral hernias up to 3 cm. Nevertheless, patients should be informed that the skin appearance can be flawed, because of the discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer.

Gestational diabetes mellitus and pelvic floor function 6 weeks postpartum in Chinese women.

INTRODUCTION AND HYPOTHESIS: With the significant increase in its incidence, gestational diabetes mellitus (GDM) has received growing attention for its effect on pelvic floor function. This study was aimed at investigating the association of GDM with pelvic floor function and diastasis recti abdominis (DRA) in postpartum women. METHODS: This is a retrospective cohort study. At 6 weeks postpartum, 1,133 postpartum women with vaginal delivery underwent routine examinations including measurement of the pelvic floor muscle (PFM) strength and endurance, determination of the stress urinary incontinence (SUI) by questionnaire, quantification of pelvic organ prolapse (POP) and assessment of DRA. Statistical analysis was performed using binary logistic regression and multiple linear regression analysis. RESULTS: One hundred and seventy-six (176) of the 1,133 women were confirmed to be suffering from GDM, with a rate of 15.53% (176 out of 1,133). The age and pre-pregnancy body mass index of the GDM group were significantly higher than those without GDM (p < 0.05). The GDM group was more likely to have smaller gestational age and a higher chance of having to undergo a lateral episiotomy. No statistically significant differences are found in PFM endurance (B: -0.025, p = 0.462) or PFM strength (B: -0.001, p = 0.979) between women with and without GDM. And these two groups are not significantly different in terms of the prevalence of SUI (19.3% vs 20.4%), POP (35.8% vs 37.5%) and DRA (29.0% vs 25.8%; p > 0.05). CONCLUSIONS: Pelvic floor muscle function and SUI/POP/DRA prevalence of women at 6 weeks postpartum are not significantly affected by GDM.