Surgical treatment of diastasis rectus abdominis and hernias on its background

Authors

  • S. E. Podpryatov Kyiv Municipal Hospital No. 1
  • I. O. Belousov Kyiv Municipal Hospital No. 1
  • S. S. Podpriatov Kyiv Municipal Hospital No. 1
  • V. V. Ivaha Kyiv Municipal Hospital No. 1
  • V. P. Korchak Kyiv Municipal Hospital No. 1

DOI:

https://doi.org/10.11603/2414-4533.2019.3.10546

Keywords:

recti abdominis muscle diastasis, hernia, surgical treatment

Abstract

The aim of the work: to assess the effectiveness of different techniques of rectus abdominis (RA) diastasis (D) surgical correction as to the point of aim attainment and patient’s satisfaction.

Materials and Methods. 92 patients were operated on, 49 men and 43 women at the age from 40 to 72 years with body mass index from 27.2 to 48.6 kg/cm2.

Incisional hernia has 47 patients, umbilical or supraumbilical – 45.

Hernia M1 has 1 patient, M2 – 11, M3 – 42, M4 – 8, M2+M3+M4 – 30, W1 3, W2 – 48, W3 – 41.

Results and Discussion. Ramirez O.M. et al., 1990, technique with mesh placement was used for hernia closure and D liquidation in 5 cases. Even as the surgery aim had been achieved in all cases, in follow up RA fully and lateral abdominal muscles nearly fully lost their ability to contract which caused considerable restriction of patients’ trunk movement.

76 patients were treated by anterior aponeurotic sheet armoring by mesh on lay placement and nearing RA edges by this mean. Live tissue welding technique by means EK-300M1 and Patonmed EKVZ 300 apparats was used for tissue mobilization. D width in epigastrium reflected the distance between the points of RA fixation at the costal arc. Seroma occur in 3 cases leading to mesh removing. Also it was impossible to draw close RA in the case of herniation foramen more 10 cm in width. Posterior sheets of RA mobilization with its armoring by mesh and further suturing was used in 11 patients with full success. RA D is the result of wide situation their places of fixation to the costal arc which was founded in all cases, thereafter their joining is impossible due to divergence in every muscle’s contraction. In the case of coincidence of D RA and herniation hernia gape have no tendency to closing. Posterior sheets of RA mobilization with its armoring by mesh and further suturing mesh use allow to close hernia defect up to 12 cm in width and seem to be highly effective in case of hernia with the RA D background.

Combined use of endotracheal narcosis and epidural anesthesia with a prolonged epidural anesthesia throughout 4–7 days after surgery ensure painless postoperative period.

References

Benjamin, D.R., Frawley H.C., Shields, N., van de Water, A.T.M., & Taylor N.F. (2019). Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy, 105 (1), 24-34. Retrieved from: https://doi.org/10.1016/j.physio.2018.07.002 DOI: https://doi.org/10.1016/j.physio.2018.07.002

Köhler, G., Luketina, R.R., & Emmanuel, K. (2015). Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J. Surg., 39 (1), 121-126. doi: 10.1007/s00268-014-2765-y. DOI: https://doi.org/10.1007/s00268-014-2765-y

Ventral Hernia Working Group, Breuing, K., Butler, C.E., Ferzoco, S., Franz, M., Hultman, C.S., …, & Vargo, D. (2010). Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery, 148 (3), 544-558. doi: 10.1016/j.surg.2010.01.008. DOI: https://doi.org/10.1016/j.surg.2010.01.008

Sancho, M.F., Pascoal, A.G., Mota, P., & Bø, K. (2015). Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. Physiotherapy, 101 (3), 286-291. Retrieved from: https://doi.org/10.1016/j.physio.2015.04.004 DOI: https://doi.org/10.1016/j.physio.2015.04.004

Mota, P., Pascoal, A.G., Carita, A.I., & Bø, K. (2018). Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci. Pract., 35, 34. DOI: https://doi.org/10.1016/j.msksp.2018.02.004

Turan, V., Colluoglu, C., Turkyilmaz, E., & Korucuoglu, U. (2011). Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol. Pol., 82 (11), 817.

Benjamin, D.R., van de Water, A.T.M., & Peiris, C.L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 100 (1), 1-8. Retrieved from: https://doi.org/10.1016/j.physio.2013.08.005. DOI: https://doi.org/10.1016/j.physio.2013.08.005

Akram, J., & Matzen, S.H. (2014). Rectus abdominis diastasis. J. Plast. Surg. Hand Surg., 48 (3), 163-169. doi:10.3109/2000656X.2013.859145. DOI: https://doi.org/10.3109/2000656X.2013.859145

Hickey, F., Finch, J.G., & Khanna, A. (2011). A systematic review on the outcomes of correction of diastasis of the recti. Hernia, 15 (6), 607-614. DOI: https://doi.org/10.1007/s10029-011-0839-4

Emanuelsson, P., Gunnarsson, U., Strigård, K., & Stark, B. (2014). Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up. J. Plast. Reconstr. Aesthet. Surg., 67 (8), 1082-1088. DOI: https://doi.org/10.1016/j.bjps.2014.04.015

Bellido Luque, J., Bellido Luque, A., Valdivia, J., Sua­rez Gráu, J.M., Gomez Menchero, J., García Moreno, J., & Guadalajara Jurado, J. (2015). Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study. Hernia, 19 (3), 493-501. doi:10.1007/s10029-014-1300-2. DOI: https://doi.org/10.1007/s10029-014-1300-2

Cheesborough, J.E., & Dumanian, G.A. (2015). Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs. Plast. Reconstr. Surg., 135 (1), 268-276. DOI: https://doi.org/10.1097/PRS.0000000000000840

Chandeze, M.M., Moszkowicz, D., & Bouillot, J.L. (2019). Large incisional hernias: The double layer technique with anterior component separation (with video). J. Visc. Surg. pii: S1878-7886(19)30094-3. doi: 10.1016/j.jviscsurg.2019.06.014. DOI: https://doi.org/10.1016/j.jviscsurg.2019.06.014

Downloads

Published

2019-11-04

How to Cite

Podpryatov, S. E. ., Belousov, I. O., Podpriatov, S. S., Ivaha, V. V., & Korchak, V. P. (2019). Surgical treatment of diastasis rectus abdominis and hernias on its background . Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (3), 51–56. https://doi.org/10.11603/2414-4533.2019.3.10546

Issue

No. 3 (2019)

Section

EXPERIENCE OF WORK

License

Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  
  2. Лицензия Creative Commons
  3. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  4. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)