Laparoscopic Repair of Diastasis of Recti

C Palanivelu, P Senthilnathan, P Praveen Raj, R Parthasarthi, P S Rajan, V Vaithiswaran, Singh Jasmeet, Jai Ganesh. GEM Hospital & Research Centre

 Introduction
Rectus abdominis diastasis or divarication of recti is a term used to define the split between the two rectus abdominis muscles. It is common in pregnancy and persists in 30-60% of women at different sites along linea alba. Primary diastasis occurs following excessive exercise and secondary occurs during or following pregnancy. For some women it returns to normal on its own but many times it persists. Other etiological factors include abdominal distension, advanced age, familial weakness of abdominal musculofascial tissues. Indications for surgery for diastasis are controversial and mainly includes pain and cosmesis.
Patient and technique
34 year old female presented with history of lax abdominal wall with discomfort in abdominal after stressful activity for three years. On examination she was diagnosed to have diversification of recti and because of her symptoms and her wish for tight abdomen, we planned laparoscopic repair.
Team setup
Patient was placed supine in Trendelenburg position. Surgeon was at her right shoulder with cameraman near her left shoulder. Monitor was at foot end.
Port Placement
Pneumoperitoneum was achieved using Veress needle at epigastrium. 10mm port was placed at epigastrium for 300 camera and 5mm working ports were created in left and right hypochondrium.
Procedure
The defect was plicated using No.1 loop nylon and 15 by 20cm Gortex mesh was placed using four transfacial and multiple intracorporeal sutures.
Outcome
The procedure was completed in 80 minutes without any intraoperative complication. Patient was discharged on 2nd postoperative day.
Conclusion
Our technique of management of diversification of recti laparoscopically is feasible and reproducible with good outcomes.