Mesh Abdominoplasty for Severe Rectus Diastasis (With/Out an Associated Incisional Hernia)

Some patients, both women and men, have a significant separation of their rectus abdominis muscles. This is called rectus diastasis (or diastasis recti), a very common condition caused typically by pregnancy that widens the linea alba. The linea alba is the width of one’s small finger in the teenager years, but it can stretch to even 10 cm across. The stretching is centered on the umbilicus in females. In men, the condition occurs from pressure inside the abdomen with coughing, heavy lifting, and weight gain that causes the linea alba to widen. The easiest way to see if you have rectus diastasis is to watch your abdomen while you descend performing a sit-up. The linea alba bulges out while the two rectus muscles are contracting inward during this exercise.

The problem caused by severe cases of rectus diastasis is that the abdominal muscles are not in their ideal position for optimal physical function. The muscles are not at their best resting length, and therefore do not work well. A lack of a sense of core causes patients to develop back pain, and difficulty with sustained movements of the trunk. Patients have a sensation that their intestines are “falling out”. However, there is no medical risk of bowel obstruction from even the most severe cases of rectus diastasis, because the interior abdominal lining is smooth for this condition, and bowel does not get caught or strangulate. On the other hand, epigastric and umbilical hernias are associated with rectus diastasis, and these two hernia conditions can be associated with bowel strangulation. Therefore, epigastric and umbilical hernias should be repaired when found. Also, the performance of even a short midline incision (by general surgeons, gynecologists, or urologists) in patients with a preexisting rectus diastasis is a prime cause of some very large midline incisional hernias developing due to the preexisting weakness of the tissue.

Dr. Dumanian has pioneered a unique technique to repair the worst cases of rectus diastasis, with or without an associated incisional hernia. Called a “mesh abdominoplasty”, he uses the same principles to treat the worst cases of rectus diastasis as he does for his incisional hernia repairs. One principle of these surgeries is that the entire linea alba should be reinforced with permanent mesh, rather than simply trying to patch a hole. A second principle is that the distribution of forces with the mesh significantly reduces the chances for suture pull through and hernia recurrence. Third, the attention to detail for skin blood flow helps to ensure primary healing. Dr. Dumanian recently published an article documenting the successful outcomes of this technique in both male and female rectus diastasis patients, with or without incisional hernias.