Mesh Repair of Rectus Diastasis for Abdominoplasty is Safer than Suture Plication
Rachita Sood1, Lindsay E Janes1, Nikita Shah1
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Abstract:
Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication.
Methods:
Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last set of office photographs.
Results:
Surgical site occurrence rate was 0% of the 40 patients in the mesh group and 19% of the 37 patients in the standard group (P = 0.005); rates of soft-tissue revision were 23% in the mesh group and 27% in the standard group (P = 0.84). As to aesthetics, the mesh abdominoplasty patients had mean statistically lower preoperative scores in comparison with the standard plication group (65.8 ± 11.6 versus 70.3 ± 11.4, P = 0.0013). The mesh group had a statistical improvement to 75.9 ± 12.6 (P < 0.0001), whereas the standard plication group improved to 82.5 ± 11.4 (P < 0.0001).
Conclusions:
Retrorectus mesh placement in a cohort of patients with severe rectus diastasis had a complication rate lower than that seen in a cohort of patients with less severe rectus diastasis, therefore negating our original hypothesis. This was done without compromising aesthetic improvement.
Insights
Mesh abdominoplasty for severe rectus diastasis showed a 0% complication rate, significantly lower than traditional suture plication. This technique improved aesthetics without increasing complications, challenging previous concerns.
Area of Science:
- Plastic Surgery
- Abdominoplasty Techniques
- Surgical Innovation
Background:
- Traditional abdominoplasty often avoids mesh for severe rectus diastasis due to concerns about infection, extrusion, and pain.
- Suture plication is the standard method, but may have limitations in severe cases.
Purpose of the Study:
- To evaluate the complication rate of a mesh abdominoplasty technique compared to standard suture plication for severe rectus diastasis.
- To assess the aesthetic outcomes of mesh abdominoplasty.
Main Methods:
- A retrospective review compared 40 patients undergoing retrorectus mesh abdominoplasty with 37 patients undergoing standard suture plication abdominoplasty.
- Inclusion criteria focused on patients with rectus diastasis, without concurrent ventral hernia, and who underwent skin tailoring.
- The primary endpoint was surgical site occurrence, with secondary endpoints including infection, revision rates, and aesthetic outcomes.
Main Results:
- The mesh group had a 0% surgical site occurrence rate, compared to 19% in the standard plication group (P = 0.005).
- Soft-tissue revision rates were similar between groups (23% mesh vs. 27% standard, P = 0.84).
- Both groups showed aesthetic improvement, with the mesh group achieving statistically significant preoperative scores compared to the standard group.
Conclusions:
- Retrorectus mesh placement for severe rectus diastasis resulted in a lower complication rate than previously hypothesized.
- The mesh technique did not compromise aesthetic improvement and offers a viable alternative to suture plication.
