Diastasis recti: interventions and techniques
The interventions aimed at treating the diastasis recti are aimed at the rapprochement of the rectus muscles and then their realignment on the midline of the abdomen allowing them to function properly and restoring their restraining function.
With the aim of achieving this in the various historical periods, numerous approaches have been proposed considering not only the anatomical ideal but also the available instrumentation and the technical possibilities of the moment.
In order to classify the various techniques, it is necessary to describe the structural characteristics as well as the access route (large or small external incisions), the anatomical working plane and finally the instruments/materials used.
The robotic trans-abdominal pre-peritoneal technique (R-TAPP) is our preferred technique because of its results. It is performed through small access routes and is placed in the penultimate layer of the abdominal wall, a space referred to as the pre-peritoneal.
It does not require extensive dissections, so no Drengraving tubes are required. A very anatomical alignment of the rectus muscles is achieved.
If, on the basis of tissue characteristics, there is an indication to place a net, it will be positioned in the preperitoneal plane, resulting in a safe area that prevents contact with the intestine.
Due to the particular area of mesh placement, no fixation device is required; lightweight, self-fixing, partially resorbable mesh is used.
These procedures are performed under general anesthesia like all other techniques.
Both robotic instrumentation and aspecific, truly skilled team are required to perform these procedures.
Techniques that approach the abdominal wall anteriorly can be performed during abdominoplasty (tummytuck), through the large incisions typical of the procedure.
Or as proposed more recently indoors, with small endoscopic access routes.
In both cases, however, extensive dissection of the panniculus adiposus is necessary to expose the anterior muscle-tendon surface. An anterior approach suture of the rectus muscles is then performed manually or endoscopically.
The umbilicus must be disengaged and Drreinforcement tubes are placed to be maintained for a variable period postoperatively. A reinforcing mesh may be placed and must be secured with sutures or anchors (called tucks) if the procedure is performed endoscopically.
This network is located in a rather superficial plane, and although there is no danger of contact with the intestine, in some conditions (particularly in very thin patients) it can be very close to the skin. These techniques require in any case, in all their variants, general anesthesia.
Posterior endoabdominal techniques
The approach of the rectus muscles is done by working totally in the abdominal cavity, through a suture on the posterior side of the abdominal wall.
Finally, mesh is placed inside the abdominal cavity.
This net must be fixed with special anchors called tucks (tucks are means of fixing nets made of spirals or anchors of various metallic, plastic or polymeric materials).
Inevitably, in all variants of these techniques, once the reconstruction is complete, one side of the network is in direct contact with the intestine as well as part of the anchors of fixation..
All of these procedures require general anesthesia in any of their variations.