The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options

Background/aim Diastasis recti abdominis (DRA) is defined as a separation of the 2 muscle bellies of rectus abdominis. To date there is scant knowledge on prevalence, risk factors, and consequences of the condition. The present study aimed to investigate the prevalence of DRA during pregnancy and post partum, presence of possible risk factors, and the occurrence of lumbopelvic pain among women with and without DRA. Methods This prospective cohort study followed 300 first-time pregnant women from pregnancy till 12 months post partum. Data were collected by electronic questionnaire and clinical examinations. DRA was defined as a palpated separation of ≥2 fingerbreadths either 4.5 cm above, at or 4.5 cm below the umbilicus. Women with and without DRA were compared with independent samples Student's t-test and χ2/Fisher exact test, and OR with significance level >0.05. Results Prevalence of DRA was 33.1%, 60.0%, 45.4%, and 32.6% at gestation week 21, 6 weeks, 6 months and 12 months post partum, respectively. No difference in risk factors was found when comparing women with and without DRA. OR showed a greater likelihood for DRA among women reporting heavy lifting ≥20 times weekly (OR 2.18 95% CI 1.05 to 4.52). There was no difference in reported lumbopelvic pain (p=0.10) in women with and without DRA. Conclusions Prevalence of mild DRA was high both during pregnancy and after childbirth. Women with and without DRA reported the same amount of lumbopelvic pain 12 months post partum.

Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy, and has been related to lumbopelvic instability and pelvic floor weakness. Women with DRAM are commonly referred to physiotherapists for conservative management, but little is known about the effectiveness of such strategies.

One hundred years ago, Edoardo Bassini said: "L'ernia é una malattia meccanica." Before that, Ambroise Paré (1598) and Joseph-Pierre Desault (1798) asserted the mechanical nature of strangulation. Beside strangulation, the most serious of all complications even today, I have studied huge hernias, which are natural complications, and recurrent hernias, which are the complications of suboptimal repairs. In this article, I consider the general features and diagnostic and technical consequences of the repair of groin and incisional hernias. The treatment of strangulating hernias, usually an emergency operation, has not seen any recent technical progress. Huge and recurrent hernias, however, usually allow time for adequate surgical preparation. These hernias are also amenable to modern prosthetic repairs. In prosthetic repairs, large pieces of polyester mesh are inserted beneath the muscular wall outside the peritoneum. They act as artificial, nonabsorbable endoabdominal fascia, making the abdominal wall instantly and definitively pressure tight. The state of hernial surgery has advanced to the point that one must consider the systematic surgical cure of all diagnosed hernias.