Sunday, October 10, 2004

Long Term Follow-up of the Correction of Rectus Diastasis with Two Different Techniques

Oscar A. Zimman, MD, PhD, Carlos D. Butto, Claudia B. Peiretti, and Arturo A. Figueroa.

Introduction. Correction of the rectus abdominis diastasis (RAD) is a common technique performed by most surgeons during abdominoplasty. The purpose of this study was to compare two different techniques: conventional anterior rectus sheath plication and imbrication. This study was designed to assess the usefulness of creating a raw surface to ensure the durability of the procedure.

Material and Methods. A prospective study including 20 patients with a diagnosis of abdominal lipodystrophy was performed (October 2001- November 2002); 19 pts were women. No abdominal hernias were present. All patients underwent a horizontal abdominoplasty under general anesthesia and muscle relaxation with treatment of the abdominal wall. Pts were assigned to two groups: group A, conventional plication ( n= 11) in one layer and group B (n= 9) aponeurotic imbrication with Nylon 0 sutures. In both groups, RAD was measured intraoperatively at three levels: above, below and at the level of the umbilicus and stapled at both edges. Radiological control of the staples was performed 3 months and one year postoperatively. At that time, the distance was measured by ultrasonography and compared with the intraoperative data at the three levels described previously.

Results. Statistical analysis was performed with the t test, comparing intraoperative measurements with those obtained by ultrasound at the three levels described previously. Results were the following: 1) supraumbilical area p: 0.801; not significant (NS) 2) umbilical area p: 0.7691 (NS) 3) infraumbilical area p: 0.950 (NS). In this group, if n had been double the value, the result would had been statistically significant.

Conclusions. In the treatment of RAD, the creation of a raw surface to mantain the repair of the abdominal muscles is not better than conventional plication, although in a larger series of cases the infraumbilical area may change the results. With both methods (plication and imbrication) is a long lasting procedure. Ultrasonography is a reliable diagnostic method.

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