Rectus Abdominis

BackgroundDiastasis of the rectus abdominis muscles (DRAM) is characterised by thinning and widening of the linea alba, combined with laxity of the ventral abdominal musculature. This causes the midline to "bulge" when intra-abdominal pressure is increased. Plastic surgery treatment for DRAM has been thoroughly evaluated, though general surgical treatments and the efficacy of physiotherapy remain elusive. The aim of this systematic literature review is to evaluate both general surgical and physiotherapeutic treatment options for restoring DRAM in terms of postoperative complications, patient satisfaction, and recurrence rates.MethodMEDLINE®, Embase, PubMed, PubMed Central®, The cochrane central registry of controlled trials (CENTRAL), Google Scholar, and the Physiotherapy Evidence Database (PEDro) were searched using the following terms: 'rectus diastasis', 'diastasis recti', 'midline', and 'abdominal wall'. All clinical studies concerning general surgical or physiotherapeutic treatment of DRAM were eligible for inclusion.ResultTwenty articles describing 1.691 patients (1.591 surgery/100 physiotherapy) were included. Surgical interventions were classified as plication techniques (313 patients; 254 open/59 laparoscopic), modified hernia repair techniques (68 patients, all open), and combined hernia & DRAM techniques (1.210 patients; 1.149 open/40 hybrid). The overall methodological quality was low. Plication techniques with interrupted sutures and mesh reinforcement were applied most frequently for DRAM repair. Open repairs were performed in 85% of patients. There was no difference in postoperative complications or recurrence rate after laparoscopic or open procedures, or between plication and modified hernia repair techniques. Physiotherapy programmes were unable to reduce IRD in a relaxed state. Though reduction of IRD during muscle contraction was described.ConclusionBoth plication-based methods and hernia repair methods are used for DRAM repair. Based on the current literature, no clear distinction in recurrence rate, postoperative complications, or patient reported outcomes can be made. Complete resolution of DRAM, measured in a relaxed state, following a physiotherapy training programme is not described in current literature. Physiotherapy can achieve a limited reduction in IRD during muscle contraction, though the impact of this finding on patient satisfaction, cosmesis, or function outcome is unclear.

PurposeDiastasis recti abdominis (DRA) or rectus diastasis is an acquired condition in which the rectus muscles are separated by an abnormal distance along their length, but with no fascia defect. To data there is no consensus about risk factors for DRA. The aim of this article is to critically review the literature about prevalence and risk factor of DRA.MethodA total of 13 papers were identified.ResultsThe real prevalence of DRA is unknown because the prevalence rate varies with measurement method, measurement site and judgment criteria, but it is certainly an extremely frequent condition. Numbers of parity, BMI, diabetes are the most plausible risk factors. We identified a new anatomical variation in cadaveric dissection and in abdominal CT image evaluation: along the semilunar line the internal oblique aponeurosis could join the rectus sheath with only a posterior layer, so without a double layer (anterior and posterior) as usually described. We conducted a retrospective review of abdominal CT images and the presence of the posterior insertion only could be considered as a risk factor for DRA.ConclusionFurther studies with large sample size, including nulliparous, primiparous, pluriparous and men too, are necessary for identify the real prevalence.

Cancer cachexia is a major cause of patient morbidity and mortality, with no efficacious treatment or management strategy. Despite cachexia sharing pathophysiological features with a number of neuromuscular wasting conditions, including age-related sarcopenia, the mechanisms underlying cachexia remain poorly understood. Studies of related conditions suggest that pathological targeting of the neuromuscular junction (NMJ) may play a key role in cachexia, but this has yet to be investigated in human patients. Here, high-resolution morphological analyses were undertaken on NMJs of rectus abdominis obtained from patients undergoing upper GI cancer surgery compared with controls (N = 30; n = 1,165 NMJs). Cancer patients included those with cachexia and weight-stable disease. Despite the low skeletal muscle index and significant muscle fiber atrophy (P < 0.0001) in patients with cachexia, NMJ morphology was fully conserved. No significant differences were observed in any of the pre- and postsynaptic variables measured. We conclude that NMJs remain structurally intact in rectus abdominis in both cancer and cachexia, suggesting that denervation of skeletal muscle is not a major driver of pathogenesis. The absence of NMJ pathology is in stark contrast to what is found in related conditions, such as age-related sarcopenia, and supports the hypothesis that intrinsic changes within skeletal muscle, independent of any changes in motor neurons, represent the primary locus of neuromuscular pathology in cancer cachexia.

PURPOSE: The optimal technique for rectus diastasis (RD) repair, particularly when a ventral hernia is present, remains undefined. Mesh suture is a novel device designed to resist suture pull-through in high-tension closures. This study evaluates the technical feasibility and early outcomes of mesh suture use for linea alba plication during open abdominoplasty, with and without concurrent ventral hernia repair. METHODS: A retrospective review of consecutive cases of abdominoplasty with mesh suture linea alba plication was performed between January 2023–2025. Patients who underwent concurrent procedures (hernia repairs, hysterectomies, and tumor excisions) were included. Patients were excluded if planar mesh was used. RESULTS: Forty-seven patients met inclusion criteria. The average BMI was 26.6 and mean age was 47.9 years. The mean RD width was 5.0 cm. 51% of patients had an existing preoperative ventral hernia and 61.7% of patients underwent a concurrent procedure. Most patients had a standard low transverse incision (68.1%). There was one superficial infection (2.1%), four seromas (8.5%), one hematoma (2.1%), and four soft tissue breakdowns (8.5%). There were no chronic draining sinuses, fistulae, chronic pain, or suture palpability reported. There was one early hernia recurrence (4.2%) among a patient with a preoperative hernia. CONCLUSIONS: Mesh suture appears to be a feasible option for RD plication in patients undergoing abdominoplasty with and without concurrent hernia repair or other abdominal procedures and was associated with low short-term complication rates in this small, single-surgeon series. These early findings, while encouraging, reflect a heterogenous and limited cohort, and follow up was insufficient to assess long-term recurrence, particularly in patients with hernias > 1 cm. As an initial feasibility study, this work supports further investigation in larger, well-controlled cohorts, ideally stratified by hernia size and with prospective, long-term follow up, to evaluate the durability, safety, and generalizability compared to standard practices.