diastasis recti borderline cases
diastasis recti, can occur in a wide range of severity depending on the many variables in its pathophysiology.
Through our clinical activities over the years, we have become a true international reference for borderline cases, which find a comprehensive answer in our surgery.
Cases on the Edge, how a young mom's life has changed
From the images under stress and at rest, the severity of the pathology can be perceived; due to the wall defect, there was no protection of the abdominal organs, so the patient had to maintain the restraining bandage every day.
This case is considered borderline in severity of IRD (inter recti distance) as well as superficial and deep tissue dystrophy.
The patient had total loss of abdominal containment, and the only tissue left to minimally contain the viscera was the skin, which was also dystrophic and heavily damaged.
The clinical picture occurred in outcomes of the second pregnancy, normal weight patient , normal build and young age.
Completely normal physical activity was not possible because of the postural and locomotor deficits, and ultimately the obvious blemishes penalized the girl emotional level in a major way.
We opted for a solid and functional reconstruction , but one that would also allow this young patient to have the best possible aesthetics, performing the so-called Triad ®.
Therefore, the intervention was carried out by associating:
1) Pre-peritoneal transabdominal robotic reconstruction, which allowed reconstruction of the anatomical integrity of linea alba in orthotopic position (i.e., in its original position) by closing in vast wall defect and restoring containment to the abdomen
2) The leveling of panniculus adiposus with liposculpture and lipofilling (especially in regions where superficial tissue dystrophy had compromised it the most)
3) Removal of excess skin that required a complete abdominoplasty (tummytuck) with transposition and umbilical replantation.
The course was completely smooth, and the patient was discharged on postoperative day 4 with a complete level of autonomy.
This was followed by a home convalescence phase that lasted no more than two weeks.
The patient was advised to continue wearing the restraining bandage for two months after surgery and to reintroduce physical activity gradually.
Borderline cases, diastasis progressively aggravated over time
This borderline case of diastasis recti allows us to reason about some concepts inherent to the possible clinical evolution of the pathology if not treated in time.
The patient had developed aninitial abdominaldiastasis many years earlier during pregnancy, the condition then worsened in a slowly progressive manner resulting in a clinical picture with locomotor and thoracic-abdominal compartmental aspects.
Therefore, it was not just an aesthetic necessity, and the reconstruction was planned after a thorough preoperative study given some comorbidities that had accumulated over the years.
Therefore, a minimally invasive reconstruction was needed but one that would provide great tightness given the extent of the pathology.
The procedure was performed in robotic surgery through millimeter access routes and exploiting the pre-peritoneal plane with the method R-Tapp (Dr. Darecchio).
The type of reconstruction is very respectful of the anatomy because it does not involve materials in contact with the viscera or perceptible on the surface.
The surgery allows very solid realignment of the rectus muscles and reconstruction of linea alba in orthotopic position (that is, in its natural location).
The patient therefore recovered full function , radically resolving the condition at the age of more than 70 years.
Borderline cases, Visceral obesity--what about diastasis?
In this case we see two main issuesvisceral type obesity and a very severe diastasis recti .
Surprisingly, for years the patient did not know she had diastasis because the dieticians she had relied on had not considered this evidence.
Then reading about it, the patient suspected that she had it and finally came to us.
Diastasis and obesity gave rise to a vicious cycle from which it was difficult to escape.
Visceral-type obesity did not allow for immediate diastasis intervention.
A drastic weight loss was needed to prepare the case for surgery, but the patient was initially not very motivated, partly because of previous experiences.
The diets she had in fact undertaken had proved consistently disappointing, despite the actual weight loss in fact, her abdomen remained bulky because of the large diastasis (which she did not know she had).
The preparatory course took more than a year but resulted in reaching the ideal body weight to undergo the surgery.
The chosen technique had to be extremely durable (given the large IRD) and provision had to be made for the removal of a considerable area of excess skin.
We therefore opted for an R-Tapp robotic reconstruction combined with a miniabdominoplasty (tummytuck).
The surgery and postoperative course went smoothly due to proper preparation with weight loss.
The result so important is due to several factors including the type of surgery that does not alter the anatomy and the patient's excellent basic structure that once the obesity and diastasis were resolved, she was able to emerge.
Borderline cases, asymmetric diastasis and recurrent umbilical hernia
In this case we see a rather frequent situation that has nevertheless generated a real borderline case.
The patient was initially suffering from diastasis recti post-pregnancy and moderate umbilical hernia.
The first doctors she went to had not recognized the diastasis and had subjected the patient to simple umbilical hernia repair.
As we have mentioned many times before, this is the prerequisite for herniarial recurrence, which in fact was not slow to manifest, adding to the pre-existing diastasis and aggravating it.
The abdomen was severely asymmetrical because of the recurrent large herniated chamber that had altered the thickness of the panniculus adiposus.
The patient lived with the restraining bandage every day and had both postural and locomotor deficits as well asfrequent episodes of hernial engagement.
We planned a surgery consisting of one from the removal of the old displaced mesh and a reconstruction to permanently resolve the abdominal wall defects
Both times were performed in robotic surgery , and the reconstruction was R-Tapp type, which allowed solid closure of the diastasis and hernia by taking advantage of the preperitoneal space.
There was also in the same session corrective action on the asymmetries of the panniculus adiposus with liposuction and lipofilling , and a considerable amount of excess skin was finally removed.
The patient was discharged after three days of hospitalization, and within two weeks she had completed her recovery at home.
In the following months, there was gradual resumption of physical activity, and the patient began to engage in the gym on a regular basis again.
