Choice of Alternative Method of Surgical Intervention in Abdominal Rectus Diastasis with Concomitant Midline Hernias

Abstract

INTRODUCTION: To date, no consensus has been achieved on the most appropriate surgical method for the treatment of abdominal rectus diastasis concomitant with midline hernias.

AIM: Study of the results of three original methods of surgical treatment of patients with abdominal rectus diastasis concomitant with midline hernias.

MATERIALS AND METHODS: The results of treatment of 74 patients have been analyzed. The patients were divided into three comparable groups: in the first group (n = 25), repair with local tissues with formation of aponeurotic duplication was performed, in the second group (n = 24), autodermal de-epithelialized graft was used, in the third group (n = 25) — mesh sub-lay implants. The following parameters were evaluated: duration of narcotic analgesia in the postoperative period, period of activation of patients, periods of inpatient treatment and results on Clavien-Dindo and EuraHSQoL scales. The follow-up period was from 1 to 10 years after surgery.

RESULTS: The period of postoperative use of narcotic analgesics was 1.08 ± 0.38 days in the first group, 0.98 ± 0.33 days in the second group, 2.13 ± 0.93 days in the third group. The period of activation was 3.00 ± 1.53 days in the first group, 0.89 ± 0.36 days in the second group, 1.5 ± 0.48 days in the third group; the duration of inpatient treatment was 9.24 ± 1.88 bed-days, 6.34 ± 3.04 bed-days and 8.36 ± 2.14 bed-days, respectively. Postoperative complications in the first group were CDI class 6, CDII class 3, in the second group CDI class 1, in the third group CDI class 6, CDII class 3. At 12 months after the operation, painful sensations and functional discomfort on EuraHSQoL scale were absent in the second group, in the first and third groups, limitations in physical activity were noted (р ≤ 0.05; differences between the first and third groups were statistically insignificant, p ≥ 0.05). There were no statistically significant differences in the cosmetic discomfort between the groups (p ≥ 0.05).

CONCLUSION: A safer and more effective method of repair of the anterior abdominal wall in patients with concomitant abdominal rectus diastasis and midline hernias is plastic surgery with application of de-epithelialized autodermal graft.

Keywords

abdominal rectus diastasis / midline hernias / surgical treatment / complications / surgery

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