Indraneil Mukherjee, MD, Aleksandr Demin, DO, Noorani Aaquib, MD, Andrey Mironenko, MD, Karen E Gibbs, MD, Aleksandra Ogrodnik, MD. Staten Island University Hospital
Introduction: Diastasis of the rectus abdominis muscles (DRAM) is a condition characterized by separation of the rectus muscles due to a laxity at the linea alba usually due to increased intraabdominal pressure over a long period of time. Pregnancy causes a substantial morphological change on the abdominal muscles and is a known risk factor for the development of DRAM. Its incidence in childbearing women is 66% and can persist in 30–60% of women postpartum. In this particular population, persistent diastasis after physical therapy and can become a debilitating diagnosis. Other causes of the condition are obesity, conditions that increase intra-abdominal pressure and known connected tissue disorders. There have been many approaches in treating this condition, from physical therapy to open surgery, with varied results. We report the case of a postpartum woman presenting with severe DRAM who underwent robotic-assisted laparoscopic plication of rectus abdominis and mesh reinforcement.
Video Case Presentation: We present a case of a 39-year-old lady with four previous pregnancies, who presented with severely debilitating persistent diastasis recti after a year of her last child’s birth. This had been causing her functional impairment in her daily activities and extreme difficulty in changing position especially sitting up from lying position. She complained of severe back pain and unable to take care of her children. A Computed tomography (CT) of the abdomen showed evidence of rectus diastasis, with an inter-rectus distance measuring 17 cm.
A robotic-assisted minimally invasive approach was used to create a pre-peritoneal plane from the suprapubic area to the xiphisternum. The abdominal wall was plicated using a running barbed suture and a coated lightweight polypropylene mesh was placed in the pre-peritoneal plane. The mesh was secured with a combination of tacks and transfacial sutures. The peritoneum was closed with absorbable sutures. Within a week the patient had shown significant improvement in her functional status and her ability to sit up from laying position without assistance.
Discussion: Multiple ways to approach severe diastasis recti has been described in various literature. We do not think physical therapy and non-operative management is proper when there is a functional loss of the abdominal wall. We do think Plication without Mesh has a high chance of failure. We do advise minimal invasive plication and sublay mesh is the best approach for quick functional recovery of the abdominal wall.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94462
Program Number: V203
Presentation Session: Panel: How Would You Approach This? Complex and Challenging Hernia Case Presentations
Presentation Type: Panel