Laparoscopic diastasis recti repair and umbilicus reconstruction - a video vignette

Diastasis of the rectus abdominis muscles (DRAM) is characterized by thinning and widening of the linea alba, combined with laxity of the ventral abdominal musculature. The linea alba runs from the xiphoid process of the sternum to the superior pubic ligament. Its tension is regulated by the pyramidalis muscles anterior to the rectus abdominis above the pubic symphysis. During pregnancy, the geometry of the abdominal muscles changes, still maintaining their function 1. An impairment characterized by the separation of the two rectus abdominis muscles along the linea alba has been defined as DRAM. A separation of the two medial edges of the rectus muscles of > 2 cm must be considered pathological. In clinical practice, different measurement methods of DRAM may be applied: palpation, tape measure, calipers, ultrasound, CT and MRI 2. The anatomical measurements and ultrasound are the most affordable and reproducible examinations and generate similar findings. In the absence of efficacy of the conservative treatment with high aesthetic or functional discomfort or the presence of a hernia, surgical intervention is often used. Plication techniques with running sutures and mesh reinforcement are applied most frequently for DRAM repair. Most studies have described the use of mesh reinforcement 3, 4. The procedure (Video S1) includes a row of multiple running absorbable sutures and an intraperitoneal onlay mesh. No drains are used. Minimally invasive or open techniques are available but the laparoscopic approach leaves the anatomical myofascial continuity intact and can protect the DRAM patient from the risk of incisional hernia formation.