PURPOSE: Rectus sheath plication during abdominoplasty is the standard treatment for diastasis of the rectus muscles to improve abdominal contour. Essential to this repair is a lasting correction of this diastasis using sutures to reapproximate the rectus muscles along the midline. There is currently a debate as to whether absorbable versus non-absorbable rectus plication accomplishes the lowest rate of recurrence. This study reviews a single surgeon’s experience with absorbable suture rectus plication.
METHODS AND MATERIALS: This is a retrospective study from the senior author’s own cohort of female patients that underwent abdominoplasty from 2018 to 2022. Only patients that followed up longer than 6 months were included in this analysis to assess long term correction of diastasis. Plication of the rectus muscles was performed with a combination of interrupted, buried, figure of eight #0 PDS (Ethicon, Somerville, New Jersey) and running #0 Maxon (Covidien, Mansfield, Massachusetts). Outcomes were assessed by physical examination at post-operative visits.
Via chart review, an analysis was also performed on patient factors such as number of pregnancies and the types of deliveries, history of prior abdominal surgeries before abdominoplasty, and whether a concurrent hernia repair was performed.
RESULTS: From 2018 to 2022, 71 patients had follow up data >6 months. Average values are as follows: Age, 43; BMI, 27 kg/m2. The average number of follow up visits in the first 6 months post-operatively was 5. 43 patients (61%) had previous abdominal surgery. The most common previous abdominal surgery was a caesarean section (41%, n=29), with the average number of previous pregnancies being 2. 1 patient had a prior abdominoplasty performed and presented for revision. 20 patients (28%) had a hernia repair at the time of abdominoplasty. 50 patients had follow up data >9 months. Average values are as follows: Age, 44; BMI, 27 kg/m2. The average follow up time post-operatively was 18 months. 31 patients (62%) had previous abdominal surgery. The most common previous abdominal surgery was a caesarean section (46%, n=23), with the average number of previous pregnancies being 2. 12 patients (24%) had a hernia repair at the time of abdominoplasty.
Correction of rectus diastasis was performed in all patients in both groups with a recurrence rate of 0 percent.
CONCLUSION: Abdominal wall plication using a double-layered, absorbable suture closure is a safe, reliable, and long-lasting method to address rectus diastasis during abdominoplasty. Our technique achieved a 0 percent recurrence rate with no major complications and was unaffected by patient factors including prior pregnancies, abdominal surgeries, or concurrent umbilical hernia repairs.