Diastasis recti (rectus diastasis) or divarication of the recti is a stretching of the linea ... medial sides of the rectus abdominis muscle (increased inter-recti distance) Diastasis of the abdominal rectus muscles refers to the divarication of the two muscles supported by the central line of the abdomen, the midline. The diastase to be significant must exceed 2.5 cm
Let's start from a first important concept: Diastasis is NOT dangerous. Even if it is included in the chapter on hernia pathologies, it does not behave like a hernia, it will never strangulate or cause intestinal pathologies. To explain what diastasis recti is, we must make a brief introduction. The rectus abdominis muscles (those of the famous bodybuilders' turtle) are inserted at the top at the end of the sternum and at the bottom in the center, on the pubic bone. Like all muscles, they are wrapped in a band of fibrous tissue, a sort of covering that has a greater hold than the muscle itself. Let's now consider the belly as if it were a balloon, with the rectus muscles originating from the poles, resting on top and united in the center. If we inflate the balloon, the two muscles will tend to separate (the word diastasis means separation). and instead of being straight they curve into an arch. What happens in the abdomen. For example, during pregnancy the belly, like a balloon, swells and the rectus muscles move apart, only to reunite when it deflates. This also happens in men who, by constitution, tend to increase the volume of their abdomen over time and with being overweight. But even when the two muscles have separated, the underlying fascia remains solid. The consequence is that when abdominal pressure increases, we will see a sort of bulge that can go from a sausage to half a watermelon depending on how much the rectums have separated. From a practical point of view, the patient notices this when he makes the effort to get up while lying down. Only then will he see it. Many people are unnecessarily scared at that sight. In 90% of cases, diastasis should NOT be treated with surgery. In recent years there has been a growing interest in diastasis recti by the international scientific communities and several consequences have been identified in cases of advanced diastasis (with a separation of the rectus muscles greater than 4-5 cm). It is being studied whether it can accentuate spinal pain or functional disorders of the pelvic organs such as the bladder. Warning: If the swelling occurs after abdominal surgery it could be a hernia which has very different characteristics and treatments (see chapter: INCISIONAL ABDOMINAL WALL HERNIA).I generally prescribe a CT scan of the abdomen under stress and without contrast medium to visualize the characteristics of the diastasis more precisely.
TREATMENT: Only after an interview with the patient, after having studied the CT scan of the abdomen, based on the symptoms and the aesthetic damage, is it decided whether to intervene surgically or rely on a conservative treatment.
NON-SURGICAL TREATMENT: In this case it is necessary to follow a dietary plan for an adequate weight loss, associated with muscle strengthening. Therefore it would be best to rely on a NUTRITIONIST for a dietary plan and on a PHYSIATRIST who will evaluate the gymnastics and the most suitable exercises. adequate to carry out.
SURGICAL TREATMENT:
Techniques:
1. Plastic surgery of the rectus muscles during an abdominoplasty
2. Laparoscopic plastic surgery of the rectus muscles with mesh.
3. ROBOTIC plastic surgery of the rectus muscles with mesh.
1. Plastic surgery of the rectus muscles during abdominoplasty surgery.
Having been considered for years to be only an aesthetic deformity, the treatment was performed almost exclusively by plastic surgeons during an abdominoplasty. The plastic surgeon, during the operation, necessarily performed in the open, combines a PLASTIC OF THE RECTI MUSCLES, joining the muscular margins with a suture made of non-absorbable material.
2. LAPAROSCOPIC RECTALI PLASTIC.
The surgery will be performed under general anesthesia and laparoscopically. From inside the abdominal cavity, the two rectus muscles are sutured, joining them in the center on the midline, then a mesh is positioned to ensure greater stability over time. The operation lasts an average of three hours with a hospital stay of three or four days.
3. PLASTIC OF THE RECTI MUSCLES ROBOTICS: The robotic technique has significantly reduced both the time and difficulty of laparoscopic surgery and will represent the gold standard for the treatment of diastasis recti. It consists of introducing it inside the abdomen always using the laparoscopic technique. The surgery itself is similar to the laparoscopic one, but the precision of the Robot allows for advantages: The movements of the robotic instruments are extremely precise. The tools are articulated, so they reproduce exactly the movements of the hand and wrist and in this way allow the separation of the various levels in which to place the net to be carried out with millimetric precision, or to detach the adhesions, greatly reducing the risk of damage to the net. #39;intestines. The intervention is even less invasive than the laparoscopic one and is decidedly less complex. Both hospital stay and post-operative discomfort are significantly reduced. The post-operative course reproduces the laparoscopic one although patients will have a quicker recovery. faster than any other technique.
