Specialist for Diastasis Recti Treatment
Diastasis recti is primarily treated by general surgeons or plastic surgeons, depending on whether the patient requires functional repair versus cosmetic correction, with general surgeons typically managing cases with concurrent hernias or functional impairment, while plastic surgeons often address isolated diastasis with aesthetic concerns.
Primary Specialists
General Surgeons
- General surgeons manage diastasis recti using plication techniques and modified hernia repair methods, particularly when functional restoration is the primary goal 1, 2.
- They employ both open and laparoscopic approaches, with plication techniques using interrupted sutures and mesh reinforcement being most frequently applied 1.
- General surgical treatment is especially appropriate when diastasis occurs with concurrent ventral hernias or when patients experience functional symptoms like lower back pain or uro-gynecological symptoms 3, 1.
Plastic Surgeons
- Plastic surgeons traditionally treat diastasis recti through abdominoplasty with plication of the anterior rectus sheath, which remains the most commonly used technique 3.
- Classic low abdominoplasty is the most common surgical technique, typically performed as either single or double-layer plication with permanent sutures 2.
- This approach is particularly suited for patients seeking cosmetic improvement alongside functional correction 1.
Surgical Approach Selection
Open vs. Laparoscopic Techniques
- Both open and laparoscopic approaches demonstrate comparable safety and efficacy, with no significant difference in recurrence rates (0.86% open vs. 1.6% laparoscopic in patients with concurrent herniorrhaphy) 4.
- Total complication rates are similar between approaches (13.3% open vs. 14.5% laparoscopic with herniorrhaphy; 11.8% open vs. 16.2% laparoscopic without herniorrhaphy) 4.
- Open repairs are performed in approximately 85% of patients, though minimally invasive techniques are increasingly utilized 1.
Specific Surgical Techniques
- Minimally invasive laparoscopic repair can be performed using modified Rives-Stoppa principles with endo-stapler plication of posterior rectus sheaths and retromuscular mesh placement 3.
- Modified hernia repair techniques and combined hernia/diastasis repair methods are also employed by general surgeons 1.
Important Clinical Considerations
When Surgery is Indicated
- Surgical intervention is appropriate when patients experience functional symptoms including lower back pain, uro-gynecological symptoms, or discomfort at the defect level 3.
- Diastasis recti is diagnosed when inter-rectus distance exceeds 2 cm 3.
Outcomes and Complications
- Most common complications include seroma, skin dehiscence, hematoma/post-operative bleeding, and infection, with overall low complication rates across techniques 4.
- Recurrence rates are generally low regardless of surgical approach, though longer follow-up is needed for comprehensive assessment 3, 4.
Role of Physiotherapy
- Physiotherapy alone cannot achieve complete resolution of diastasis measured in a relaxed state, though limited reduction during muscle contraction may occur 1.
- Conservative physiotherapy management should be considered before surgical referral, but its impact on patient satisfaction and functional outcomes remains unclear 1.
Common Pitfalls to Avoid
- Do not delay surgical referral in patients with significant functional impairment or concurrent hernias, as these cases benefit most from surgical intervention 1.
- Avoid assuming all diastasis requires surgical treatment—assess for functional symptoms and patient goals before referral 3, 1.
- The choice between general surgery and plastic surgery should be based on whether concurrent hernia repair is needed and whether cosmetic versus functional outcomes are prioritized 1, 2.