A novel technique of midline mesh repair for umbilical hernia associated with diastasis recti

Mesh repair has evolved as the gold standard for umbilical hernias. Surgical reconstruction of umbilical hernias in association with diastasis recti has not been discussed in the recent literature. We describe a novel surgical technique of midline mesh repair for this combined lesion. This is a retrospective review of 44 consecutive patients. Forty-four patients underwent surgery for umbilical hernia with diastasis recti between January 2010 and August 2012. All excess skin, subcutaneous tissue, and distracted midline (linea alba) were excised supraumbilically and paraumbilically according to preoperative marking. Surgical repair began with a midline running suture of the posterior rectal sheath. A light prolene mesh was placed retromuscularly into this sheath and anchored in all directions with a distance of about 5 cm from the midline using U-shaped stitches. The anterior rectal fascia was closed with a continuous suture. All information was obtained from the hospital records. The median operative time was 93.3 minutes (28 to 219 minutes). The median length of postoperative hospital stay was 5.9 days (3 to 12 days). There was no major complication. One minimal umbilical skin necrosis was observed. Analgesic medication was required in all patients. Opiods were added in 84.0% of patients on day 1, in 75.0% on day 3, and in 2.3% on day 7. Our novel technique of sublay mesh repair for combined umbilical hernia and diastasis recti is safe and effectively restores the abdominal midline.