Meshabdominoplasty for rectusdiastasis inwomenandmen Vol.:(0123456789) 13 Hernia (2021) 25:863–870 https://doi.org/10.1007/s10029-021-02461-1 ORIGINAL ARTICLE Mesh abdominoplasty for rectus diastasis in women and men G. A. Dumanian1 · S. Moradian1 Received: 29 May 2021 / Accepted: 16 July 2021 / Published online: 3 August 2021 © The Author(s) 2021 Abstract Purpose Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba. Methods Inclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates. Results SSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men. Conclusion Repair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis. Keywords Mesh · Abdominoplasty · Pull-through · Retrorectus Introduction Midline hernia repairs are surgical approximations of the medial borders of the rectus muscles. The same type of tissue approximation is required for the repair of rectus diastasis. The tissue type—namely the medial border of the rectus muscles—is the same for both conditions of incisional hernia and rectus diastasis. The deforming forces are the lateral three abdominal wall muscles and the centrifugal forces of the abdominal viscera and are the same for both conditions. The only difference between surgical corrections of midline incisional hernias and rectus diastasis is that in the latter condition, the posterior sheath does not need to be repaired. In the classic study by Luijendijk [1] and in the follow-up manuscript by Berger [2], the repair of incisional hernias was found to be more complete and more reliable when meshes are used in comparison to sutures alone. The mechanism of failure leading to incisional hernia recurrence and loss of abdominal wall tightening is suture pull-through. Excessive tension on the sutures required for tissue approximation can lead to acute tearing of the tissues (dehiscence) or else the creation of scar that weakens over time from the forces applied and the development of an incisional hernia [3]. Scar is approximately 70% as strong as the underlying tissue type, and in many cases the scar is not strong enough to achieve a durable repair–hence the failure rates seen with incisional hernia repair with simple sutures [4]. Meshes distribute forces in the short term to limit suture pull-through. Over time, the filaments of meshes permit fibrovascular incorporation. The chronic foreign body response serves to create a * G. A. Dumanian [email protected] 1 Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, 675 N St. Clair, Suite 19-250, Chicago, IL 60611, USA Hernia (2021) 25:863–870 https://doi.org/10.1007/s10029-021-02461-1 ORIGINAL ARTICLE Mesh abdominoplasty for rectus diastasis in women and men G. A. Dumanian1 · S. Moradian1 Received: 29 May 2021 / Accepted: 16 July 2021 / Published online: 3 August 2021 © The Author(s) 2021 Abstract Purpose Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba. Methods Inclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates. Results SSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men. Conclusion Repair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis. Keywords Mesh · Abdominoplasty · Pull-through · Retrorectus Introduction Midline hernia repairs are surgical approximations of the medial borders of the rectus muscles. The same type of tissue approximation is required for the repair of rectus diastasis. The tissue type—namely the medial border of the rectus muscles—is the same for both conditions of incisional hernia and rectus diastasis. The deforming forces are the lateral three abdominal wall muscles and the centrifugal forces of the abdominal viscera and are the same for both conditions. The only difference between surgical corrections of midline incisional hernias and rectus diastasis is that in the latter condition, the posterior sheath does not need to be repaired. In the classic study by Luijendijk [1] and in the follow-up manuscript by Berger [2], the repair of incisional hernias was found to be more complete and more reliable when meshes are used in comparison to sutures alone. The mechanism of failure leading to incisional hernia recurrence and loss of abdominal wall tightening is suture pull-through. Excessive tension on the sutures required for tissue approximation can lead to acute tearing of the tissues (dehiscence) or else the creation of scar that weakens over time from the forces applied and the development of an incisional hernia [3]. Scar is approximately 70% as strong as the underlying tissue type, and in many cases the scar is not strong enough to achieve a durable repair–hence the failure rates seen with incisional hernia repair with simple sutures [4]. Meshes distribute forces in the short term to limit suture pull-through. Over time, the filaments of meshes permit fibrovascular incorporation. The chronic foreign body response serves to create a * G. A. Dumanian [email protected] 1 Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, 675 N St. Clair, Suite 19-250, Chicago, IL 60611, USA MAY 2022 | The Surgical Technologist | 209 Nochangesweremade to thisa ticle.
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