Diastasis recti: surgery

The availability of robotic surgery instrumentation has been a driving force in the development of less invasive procedures, especially for the treatment of this condition.

Transabdominal preperitoneal techniques (robotic surgery technique developed by Dr. Darecchio)
  • Inconspicuous scars (small incisions)

  • No surgical drain

  • Excellent muscle alignment

  • No clips/tacks/sutures required to secure mesh

  • No contact between intestine and mesh (semi re-absorbable mesh positioned in the preperitoneal space)

  • High cost (need for specific instruments and dedicated surgical team)

  • General anaesthesia (the same anaesthesia used for all surgical techniques)

Posterior intraperitoneal techniques (laparoscopic)
  • Inconspicuous scars (small incisions)

  • No surgical drain

  • Posterior muscle alignment including peritoneal tissue

  • Use of clips/tacks/sutures (of various metal, plastic and polymer materials) to secure mesh

  • Contact between intestine and mesh (permanent mesh positioned inside abdominal cavity)
  • Low cost (standard instruments and surgical team)

  • General anaesthesia (the same anaesthesia used for all surgical techniques)

Anterior techniques (open or endoscopic)
  • Large scars and extended dissections

  • Surgical drain required

  • Introflecting anterior muscle alignment

  • Permanent onlay mesh secured with sutures

  • No contact between intestine and mesh (semi re-absorbable mesh positioned in the preperitoneal space)
  • Low cost (standard instruments and surgical team)

  • General anaesthesia (the same anaesthesia used for all surgical techniques)

Robotic surgery

Transabdominal preperitoneal techniques (robotic surgery technique developed by Dr. Darecchio)

The latest generation techniques allow the surgeon to operate between two layers of the abdominal wall in an area known as the preperitoneal space. These techniques involve small incisions, require no extended dissections or surgical drains, and give an excellent anatomical alignment of the muscles on their medial margin. If a protective mesh is required at the end of the procedure (depending on the characteristics of the tissues), this will be positioned in the preperitoneal plane, providing a safe zone which prevents any contact with the skin on the surface, and with the intestine underneath. The position of the mesh requires no fixing devices, and the mesh used is generally light, self-adhesive and partially re-absorbable over time. Like the previous techniques, these procedures require the same type of anaesthesia. These procedures require robotic surgical instruments and specific expertise on the part of the surgeon.

  • No surgical drain

  • Excellent muscle alignment

  • No clips/tacks/sutures required to secure mesh

  • No contact between intestine and mesh (semi re-absorbable mesh positioned in the preperitoneal space)

  • High cost (need for specific instruments and dedicated surgical team)

  • General anaesthesia (the same anaesthesia used for all surgical techniques)

Posterior intraperitoneal techniques (laparoscopic)

The techniques involving a posterior approach to the abdominal wall were mainly developed in the ’90s using laparoscopy, and do not require large incisions. These techniques involve bringing the rectus muscles together on their posterior plane, operating entirely in the abdominal cavity. Surgical drains and large incisions are not generally required, but a mesh is normally positioned at the end of the surgery to reinforce the repair. The mesh is in direct contact with the intestine, and must be secured using special devices (generally clips or spirals known as tacks) secured to the abdominal wall and partially in contact with the intestine. All variations of these procedures require a general anaesthetic.

  • Inconspicuous scars (small incisions)

  • No surgical drain

  • Posterior muscle alignment including peritoneal tissue

  • Use of clips/tacks/sutures (of various metal, plastic and polymer materials) to secure mesh

  • Contact between intestine and mesh (permanent mesh positioned inside abdominal cavity)
  • Low cost (standard instruments and surgical team)

  • General anaesthesia (the same anaesthesia used for all surgical techniques)

Anterior techniques (open or endoscopic)

Techniques involving an anterior approach to the abdominal wall were the first to be used, and are generally also considered the most invasive, requiring an extensive dissection of the panniculus adiposus to expose the anterior surfaces of the rectus muscles and to suture the muscles together on the anterior plane. Surgical drains are positioned during this type of procedure, and left in place for a variable period of time following surgery. A mesh reinforcement is positioned over the repair and may be very close to the skin in some cases. This type of abdominal wall repair can be performed via a wide bispinoiliac incision as part of an abdominoplasty procedure, or via small incisions using an endoscopic approach, as has recently been proposed. This latter technique, however, does not eliminate the need for surgical drains, extended dissection or positioning of a mesh, albeit on a relatively superficial plane.

  • Large scars and extended dissections

  • Surgical drain required

  • Introflecting anterior muscle alignment

  • Permanent onlay mesh secured with sutures

  • No contact between intestine and mesh (semi re-absorbable mesh positioned in the preperitoneal space)
  • Low cost (standard instruments and surgical team)

  • General anaesthesia (the same anaesthesia used for all surgical techniques)