Post-partum abdominal wall insufficiency syndrome (PPAWIS): lessons learned from a single surgeon's experience based on 200 cases

Preliminary study of Kinesio Taping in rectus abdominis diastasis treatment and abdominal circumference improvement in postpartum women: a retrospective study

Rectus abdominis diastasis (RAD) is a key factor in the rehabilitation of postpartum women. This study aimed to evaluate the clinical efficacy of Kinesio Taping (KT) in RAD treatment and abdominal changes. The medical records of women with RAD who received KT treatment at the hospital were reviewed. A total of 138 women were included and their demographic characteristics were reviewed, including data before and after RAD treatment, abdominal circumference at the umbilicus and both above and below the umbilicus, as well as the distance from the xiphoid to the umbilicus, distance from the umbilicus to the pubic symphysis. The width of RAD decreased from 4.58 ± 1.74 cm to 2.33 ± 0.90 cm after KT treatment (t = P < 0.001) compared to before treatment. After treatment, the proportions of women with normal, mild, moderate, and severe RAD were 28.1%, 44.6%, 26.6%, and 0.7%, respectively, showing statistical significance (P < 0.001). A statistically significant difference was observed in the abdominal circumference reduction at the umbilicus and above and below the umbilicus before and after KT treatment. However, no statistically significant difference was noted in terms of the changes in the distance from the umbilicus to the pubic symphysis. A statistically significant difference was observed before treatment in abdominal circumference below the umbilicus between the cured and non-cured groups. Preliminary analysis results showed a positive effect of Kinesio Taping treatment in promoting rectus abdominis diastasis recovery and improving abdominal circumference. Furthermore, rectus abdominis diastasis was positively correlated with lower abdominal circumference and anterior abdominal injury.

Functional Tests of the Abdominal Wall Muscles in Normal Subjects and in Patients with Diastasis and Oblique Inguinal Hernias in a Pilot Study

OBJECTIVES

To identify typical patterns of abdominal wall muscle activation in patients with diastasis recti and inguinal hernias compared to controls during the Valsalva maneuver, voluntary coughing, and physical activity.

METHODS

The study included 15 subjects: 5 with diastasis recti, 4 with inguinal hernias, and 6 healthy controls. The functions of rectus abdominis (RA) and external oblique (OE) muscles were measured by surface electromyography (sEMG). Using ultrasound, the thicknesses of the RA, OE, internal oblique (IO), and transversus abdominis (TA) muscles were assessed as well as the echo intensity (EI) of RA and OE.

RESULTS

We found a significant effect of the type of abdominal wall pathology on the maximum sEMG amplitude (p = 0.005). There was a reliable trend in maximum sEMG amplitude, with the highest one in diastasis recti and a significantly lower one in inguinal hernias. Duncan's test showed a significant difference in muscle thickness, both on the right and left sides, between patients with diastasis and controls, but only on the left side between patients with diastasis and those with inguinal hernia (p < 0.05).

CONCLUSIONS

The abdominal wall pathology results in a change in the function and structure of the abdominal muscles, which can be detected using electromyography and ultrasound examination. The presence of diastasis recti is accompanied by an increase in bioelectrical activity and a decrease in thickness.

Linea alba 3D morphometric variability by CT scan exploration

PURPOSE

The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics.

METHODS

Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients' CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured.

RESULTS

The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001-p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007).

CONCLUSION

This study provides an exhaustive 3D description of Linea alba's anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.

The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery

BACKGROUND

Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation.

METHODS

A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery.

RESULTS

Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up.

CONCLUSIONS

Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.