Intervention diastasis recti, recurrence and complications
An important activity that sets us apart involves taking in patients from other facilities with recurrent diastasis or various complications in outcomes of previous surgeries.
Patients' attention is generally focused on the eventual recurrence of diastasis (i.e., recurrence of the pathology) however, there are complications worse than recurrence (and more difficult to resolve) that we will see in the next chapters.
Since this is second-level surgery in correction of previous procedures each case would deserve a separate discussion.
In our experience, transabdominal pre-peritoneal R-Tapp robotics has allowed us to resolve recurrences and complex cases by taking advantage of an intact and completely different work plan than before.
Diastasis recurrence, what it is, why it occurs
Recurrence of a surgical condition is defined as its recurrence, even long after surgery.
Why can a recurrence of abdominal distasis occur ?
To answer this question, one must contextualize it in the specific clinical case and then thoroughly analyze the reconstructive technique used.
There are generic risk factors and somatic characteristics predisposing to recurrence, chief among them being overweight and visceral obesity.
As mentioned several times, an intervention should not be scheduled for diastasis recti until the subject has achieved (and demonstrated the ability to maintain) a normopeso status.
Excessive weight gain following reconstruction could result in a recurrence of abdominal diastasis as well as could occur with a subsequent pregnancy.
Systemic diseases and/or state of malnutrition can also affect tissue strength and predispose to diastasis recurrence.
Beyond the generic factors listed so far, there are technical factors related to the type ofsurgery performed that can promote the occurrence of recurrence.
Which surgical technique has fewer recurrences ?
Not all diastasis surgeries have the same risk of recurrence, and the scientific literature on this is currently lacking, considering that it is based mainly on dated case histories and techniques.
Even outside the scientific literature, there is no clear picture, especially online where one should be wary of the often untruthful advertisements sensationally decrying the lack of recurrence of a certain technique.
In our clinical practice, we favor interventions with central sutures and pre-peritoneal mesh obtainable in R-Tapp robotic surgery.
Such reconstructions involve a suture that is very balanced and therefore strong, discharging forces evenly.
The mesh placed in the pre-peritoneum is very stable as it is housed in an o layer that holds it in place and insulates it from contact with the viscera.
diastasis recti recurrence, symptoms and surgical resolution
The signs and symptoms of recurrent distasis are simply the reappearance of the abdominal wall defect.
After diagnostic confirmation, surgical therapy will be considered, which will vary from case to case, mainly depending on the starting surgery.
In cases in outcomes of traditional surgery, the corrective approach generally proves easy ultilizing the R-Tapp robotic route.(Please read the specific chapter)
In contrast, the most problematic and not risk-free cases are those in laparoscopic surgery outcomes. (Please read the specific section)
In laparoscopic outcomes, in fact, the presence of adhesion syndrome, sustained by the mesh that inevitably contacts the bowel, is very common.