Treatment and outcomes of rectus diastasis in post-bariatric patients and postpartum women - a systematic review.

[BACKGROUND] Rectus diastasis is an increasing condition determining both cosmetic and functional disability that mostly affects post-bariatric patients and postpartum women. The goal of this study is to provide an updated review of open surgical techniques used for rectus diastasis repair during an abdominoplasty in these two subgroups, their comparative efficacy and eventual differences in the outcomes. Evaluation of the topic: In accordance with Systematic Reviews and Meta-Analyses guidelines, the Pubmed, EMBASE, MEDLINE, the Cochrane and Scholar databases were searched for articles from 2004 to 2024. A total of 47 studies were analysed. Among these, 5 were about one specific subgroup. The plication was done most with permanent sutures. In case of hernia, a repair with mesh was performed with at least > 1 cm of diastasis. There was no statistically significant difference in surgical complication and recurrence rates between post-bariatric and postpartum patients (P ≥ 0.05 and P ≥ 0.05, respectively).

[CONCLUSIONS] In general, surgical repair of rectus diastasis appears to be efficient but there is no evidence or unanimity about one method over another. Moreover, the quality and the number of studies treating the two categories of patients separately in literature so far is too low. Despite the plicature of the rectus muscle during surgical abdominoplasty in association with an eventual herniorrhaphy as principal treatment is known, there is a lack of defined guidelines regarding the correct approach taking into consideration the pathophysiological differences of the two subgroups. Therefore, further prospective studies are necessary in this area to improve the quality of data and reduce the bias.