Principles of rectus diastasis classification and treatment

In the last 15 years, rectus diastasis has become a relevant topic for general surgeons. There have been published different classification systems and more than 45 surgical procedures, open or laparoendoscopic, even robotic, for treatment. This article pretends to summarize the different classification system and give some insight about what surgical technique could be recommended in each case.

A literature search of publications on classification systems of rectus diastasis and its treatment was performed in three databases (PubMed, EMBASE and WOS) without time limits, in English or Spanish language.

Seven different classifications for rectus diastasis have been found and a great variety of surgical techniques, open, laparo-endoscopic or robotic. Each classification has its own particularities and only two recommend specific surgical procedures in some types of rectus diastasis. There are two main groups of patients with rectus diastasis, with or without midline hernias and in each case, different techniques could be indicated. There are no randomized controlled trials that compare different surgical techniques and in consequence, no evidence in the literature about which treatment is better in each case.

Due to the lack of knowledge in this field, the recommendation is to use the EHS classification system, the easiest and most applicable. Shared decision-making process between patient and surgeon must be mandatory to select the right treatment for the right patient. International registries can be helpful to clarify which procedure should be use in each case.