Laparosocpic Rectus Diastasis Repair

What is rectus diastasis?

Diastasis recti or divarication of rectus is a very common condition usually affecting women, typically seen following pregnancy caused by stretching of the abdominal wall by the enlarged uterus, sometimes referred to as “postpartum stomach pooch”. However it can also affect men typically those involved in bodybuilding and lifting heavy weights. Diastasis recti literally refers to a separation between the left and right side of the rectus abdominis muscles, the so called ‘6 pack’ which provide coverage for the top, middle and lower part top of the belly area.

A diastasis of the abdominal wall is not a hernia. Clinically, a diastasis may look like a hernia in the sense that when the abdomen is flexed, there is a noticeable and cosmetically unpleasing bulge, usually located in the upper abdomen in the midline, above your belly button. But there is a big difference. A hernia is a hole in the fascia. A diastasis is just stretched out midline fascia, and not a real hernia. Thus a diastasis has no real incidence of developing an emergent incarceration or strangulation. A diastasis, with stretched out midline fascia, results in your two rectus (6 pack) muscles being far apart.

How is rectus diastasis recognised?

A diastasis recti looks like a ridge, which runs on the middle of the belly area. It stretches from the bottom of the breastbone towards the navel, (and sometimes even lower towards the pubis) and increases with muscle straining.

In women who have multiple pregnancies, since the muscles have been stretched often, extra skin and soft tissue in the front from the abdominal wall could be the only signs and symptoms of this condition.

A doctor can diagnose this condition by performing a physical exam. A simple ‘sit-up’ or stomach crunch exercise will demonstrate a bulging ridge running from breastbone to navel. The degree of diastasis or divarifiction can be defined objectively on an ultrasound or CT scan.

Abdominal wall function weakness is a common symptom, and has often been reported as improved after diastasis repair. However, despite being symptomatic, a diastasis repair alone is still considered elective, cosmetic, and is therefore not reimbursed by most insurance companies.

What causes rectus diastasis?

The term diastasis means “separation” . In pregnant women, increased tension around the abdominal wall can lead to diastasis recti. Multiple births or repeated pregnancies increase the risk of divarication of rectus. Its incidence in childbearing women is 66%, commonly occurring in the third trimester, and can persist in 30–60% of women during the postpartum period as well . In men, increased abdominal pressure from weight lifting can have the same effect. Other etiologic factors include chronic or intermittent abdominal distension, advancing age, or familial weakness of the abdominal musculofascial tissues.

How is rectus diastasis repair performed?

Repair options for diastasis recti include:

• no surgery. Trial of time and / or abdominal excercises and / or physiotherapy.
• open primary repair (often done by a plastic surgeon at the same time as an abdominoplasty to removed excess skin)
• open mesh repair (This is rarely done or needed for primary diastasis).
• laparoscopic diastasis suture repair with or without mesh reinforcement. The main objective here is to use a suture to reapproximate your rectus muscles to the midline. On occasion the surgeon may combine laparoscopic diastasis repair with umbilical hernia repair should they co-exist. The benefits of the laparoscopic approach are as for any laparoscopic versus open technique, most notably improved recovery time, reduced pain and wound infection, improved cosmesis.
• Most insurance companies regard rectus diastasis surgery as cosmetic and so will not usually cover it but on occasion a case may be made stating that it affects day-to-day life (difficulty lifting stuff, including kids) and that exercise attempts have not helped.

Results of surgery

Repair for cosmesis and restoring function of the recti muscles is nearly always successful. The laparoscopic approach offered by Mr Ahmed has the immense benefit of minimizing scars. Mr Ahmed offers a minimally invasive (laparoscopic) diastasis repair. There is no skin excision, which is a big difference from a traditional plastic surgery abdominoplasty which is a much bigger operation leaving a large scar.

Risks of surgery

Recurrent diastasis recti is possible. Seromas are possible. Cosmetic results can not always be guaranteed.

Postoperative care

We advise our patients to wear an abdominal compression binder (corset) for a period of 4-6 weeks following surgery for support.

You’ll stay in the hospital for at least a night. Because your abdominal muscles are stitched back together so tightly (think of a corset that laces in the front), your back will hunch over. Pain relief with paracetemol and nuriofen Is effective but on occasion stronger
You’ll need time off work 1-2 weeks. You can’t lift your kids (or anything else) for eight weeks.

All being said – It’s worth it. If your separation is uncomfortable and unsightly and not responding to core strength excercises, affecting your posture; then having laparoscopic surgical repair is worth it. Most patients notice after this surgery – clearly improved cosmesis, better posture, improved abdominal wall function, reduced core pain and backpain.

Other tips before diastasis surgery:

Patients with obesity (BMI greater than 35) should try to lose weight to keep a body mass index less than 35 if possible. If you have obesity, it is not advised to have a diastasis repair as the recurrence rates are quite high.

You have to be done having babies. You can’t repair the abdominal wall and then blow it out again with another pregnancy.