Preliminary evaluation of surgical treatment for postpartum diastasis recti

doi:10.16139/j.1007-9610.2024.04.10

Abstract

Abstract:

Objective To evaluate the clinical efficacy, safety and the postoperative functional improvement of the surgical treatment for postpartum diastasis recti (PDR). Methods A retrospective study was conducted on the patients with PDR who underwent surgical treatment in Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University from November 2018 to October 2023. The patients’demography, operation data, postoperative complications, recurrence and functional evaluation before and after surgery were analyzed. Results A total of 39 cases were included. Open surgery was performed in 21 cases, laparoscopic surgery in 17 cases, and hybrid surgery in 1 case. On the basis of linear alba reconstruction (LAR), 26 cases were additionally repaired with Sublay mesh, 9 with Onlay, and 1 with intraperitoneal onlay mesh (IPOM); the other 3 cases were only performed with LAR. The follow-up ranged 6-45 months, and the completion rate was 92.3%. During the follow-up, no recurrence was observed, and the overall complication rate was 20.5%, including 1 case with delayed wound healing, 2 cases with seroma, and 5 cases with skin disorders in paraumbilical and subumbilical area. There were significant changes of European Registry for abdominal wall hernias quality of life (EuraHS QoL) score and Oswestry disability index (ODI) after operation, indicating significant improvement in QoL and lower back pain. The inter-recti distance(IRD) of the patients undergoing laparoscopic surgery was less than that of the patients undergoing open surgery (median 4.0 cm vs. 4.5 cm), and the duration of hospital stay of the patients undergoing laparoscopic surgery was shorter than that of open surgery (median 7 days vs. 9 days). Conclusions In general, the surgical treatment of PDR is safe and effective, and it can not only correct the separation, but also improve QoL and lower back pain of the patients. Tailored surgical procedures should be selected for patients with different conditions.

Key words: Postpartum diastasis recti(PDR), Linear alba reconstruction(LAR), Sublay repair, Onlay repair, Quality of life (QoL)

CLC Number:

R656.3
R714

LIU Lu, ZHU Xiaoqiang, LIU Nan, LIU Jiajie, TANG Rui. Preliminary evaluation of surgical treatment for postpartum diastasis recti[J]. Journal of Surgery Concepts & Practice, 2024, 29(04): 329-335.

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Item	Preoperative	Postoperative	Z value	P value
EuraHS QoL score	20(18-27.75)	12(8-22)	-3.529	<0.05
Pain of the side of the hernia	1(0-5)	0	-3.526	<0.01
Restrictions of activities because of pain or discomfort	2(0-16)	1(0-11)	-0.696	0.486
Cosmetic discomfort	16(10-20)	7.5(4-10)	-4.603	<0.01
ODI	7(1-12.75)	3(0-6.75)	-3.116	<0.05

Item	Lap（n=17）	Open（n=21）	t/Z value	P value
BMI (kg/m²)	21.2±2.9	21.4±2.1	-0.244	0.809
Age (years)	37（32-38）	36.00（32-40）	-0.162	0.871
Operative time (min)	251±98	226±44	0.942	0.357
IRD (cm)	4.0（4.0-4.8）	4.5（4.3-6.5）	-1.985	0.047
24 h VAS	4（2-6）	3（3-5）	-0.225	0.822
48 h VAS	3（1-5）	3（1-4）	-0.665	0.506
Hospital stays (days)	7（7-8）	9（7-10）	-1.975	0.048
Cost (RMB)	39 232（37 215-42 556）	35 385（31 698-47 269）	-1.659	0.097

Item	Lap Sublay（n=11）	Open Sublay（n=15）	t/Z value	P value
BMI (kg/m²)	21.7±2.8	20.8±2.2	0.916	0.369
Age (years)	36.6±5.2	36.1±6.4	-0.223	0.826
IRD (cm)	4.0（4.0-4.5）	4.5（4.5-7.0）	-2.026	0.043
Operative time (min)	280 (210-330)	220 (200-290)	-1.355	0.176
24 h VAS	3（2-4）	3（3-4）	-0.334	0.739
48 h VAS	3（1-3）	2（1-3）	-0.876	0.381
Hospital stays (days)	7（7-10）	9（7-10）	-1.413	0.158
Cost (RMB)	39 462（39 090-42 642）	35 709（33 584-47 253）	-1.583	0.113