Wide-Rectus Abdominis Fascia Advancement: A Method for Treatment of Global Abdominal Wall Distention

Global abdominal wall distention (GAWD) is a phenomenon in which patients present with significant abdominal wall laxity and abdominal bulging unexplained by a rectus diastasis, large panniculus, or abdominal wall hernia. Traditional abdominoplasty techniques do not adequately address GAWD, and treatment of this condition requires modification of the abdominal fasciomuscular complex. This paper aims to describe a novel technique, known as wide-rectus abdominis fascia advancement (WRAFA), developed to address this vexing cosmetic issue.

Over a 30-year period, patients with GAWD were identified in a single surgeon's practice, and, once deemed to be appropriate candidates, they underwent the WRAFA procedure. All patients underwent the procedure in an outpatient setting and were kept for no longer than 23 hours or transferred to a certified recovery setting with skilled nursing. Aesthetic outcomes and complications were tracked over time.

Six hundred eighty-five patients underwent abdominoplasty with the WRAFA technique. Two hundred eighty-four patients were available for follow-up for a minimum of 12 months. The average body mass index was 32. The median age was 38 years. Sex distribution was predominantly female (92.5% vs 7.75%). Aesthetic results were deemed to be good to excellent in 80% of patients, moderate in 15%, and minimal in 5%. None of the patients developed abdominal compartment syndrome. There were no fatalities or recurrences. One patient developed a unilateral lower quadrant hernia 15 years after the operation.

The WRAFA technique helps redefine the patient's waistline while addressing functional muscular dystonia, ultimately providing excellent aesthetic and functional improvements.