Surgical treatment of rectus abdominis diastasis with concomitant abdominal wall hernias-perioperative outcomes of 11,658 cases from the Herniamed Registry.

[INTRODUCTION] Due to the paucity of data, the only recommendation that can be given in the European Hernia Society guidelines is that, to characterize the patient cohort with rectus abdominis diastasis (RAD), a recognized classification system be used and that defects > 1 cm be repaired with a mesh technique. Otherwise, further studies are needed.

[METHODS] As from February 2022, it has been possible in the Herniamed Registry to also record patients with rectus abdominis diastasis (RAD) and concomitant ventral hernias separately from those with midline hernias without RAD. The classification system employed by the German Hernia Society was used to that effect. The patient- and procedure-related characteristics were recorded and the perioperative outcomes determined.

[RESULTS] Between February 2022 and January 2025, 11,658 patients with RAD and concomitant ventral hernias were recorded in the Herniamed Registry. Of these patients, 31.3% were women and 68.7% men. In 94.9% of cases, the surgical indication was based on RAD with concomitant ventral hernias. The most frequently used surgical techniques were mini-less-open and endoscopic sublay techniques at 48.9%, open techniques at 30.7% and laparoscopic techniques at 11.0%. The postoperative complication rate was 5.0% and the complication-related reoperation rate 2.3%.

[CONCLUSION] The actual situation with regard to repair of RAD with concomitant ventral hernias shows that the preferred surgical techniques are open and mini-less-open as well as endoscopic sublay. The perioperative outcomes with 5% postoperative complications and 2.3% reoperations demonstrate that the techniques are demanding.