This is a condition that presents with a ‘bulge’ commonly in the upper abdomen which is a particularly noticeable when a person stands up and/or attempts a ‘sit up’ from a lying down position. It is known as abdominal separation and occurs due to the separation of the rectus abdominis muscle commonly as a result of:
1. Weight gain in men – truncal obesity
2. Pregnancy in women (common)
This condition can be unsightly and when it is small (<2cm) it can be treated with improvement in the abdominal wall muscles as advised by a qualified physiotherapist, including core contraction, squats against the wall, upright push ups against the wall and head lifts. It is sometimes confused as a true abdominal wall hernia.
Surgery
Surgical techniques have been documented in the literature and can involve both open and minimally invasive or laparoscopic methods. Whichever technique is used, the recurrence rate is higher than for most repairs and one would quote this risk to be at least 10-15%.
Open Surgery
This involves the use of a small midline incision and plication (re-approximation) of the defect. The patient is admitted for at least 2 days and will need pain-killers for at least 1-2 weeks. Driving is permitted once an emergency stop can be made safely and one would imagine that at least 2-3 weeks is required, but return to full normal daily activities may take at least 2-3 weeks. The patients are advised to hold a small pillow around the abdominal wall repair for the first few weeks when undertaking any physical activity for comfort.
Laparoscopic repair
This method relies on the use of three small incisions on the left hand side of the abdomen and the plication or tightening of the abdominal wall from the inside of the abdomen. This tightening is then reinforced by use of an intra-abdominal mesh, which is fixed in place by small tacks. This method is usually preferred if there is a hernia present in addition to the diastasis, but it can be more painful after surgery for at least 4-7 days than the open repair. The post-operative recuperation is as the same as for open surgery but in most cases a mesh is used which will be inserted into the abdominal cavity.
The patients are advised to hold a small pillow around the abdominal wall repair for the first few weeks when undertaking any physical activity for comfort.
Endoscopic repair
This technique is the one most used and involves the creation of space under the skin and above the abdominal wall muscle. This method does not rely on ‘entering’ the abdominal cavity and is undertaken by the use of three small incisions below the umbilicus. Sometimes a mesh is used again but only if there is a hernia also present, it is generally safer but has a risk of prolonged seroma, which is fluid build up under the skin. To reduce or control seroma formation, a drain is left after the operation under the skin and this may stay in for at least a week or more after surgery. Patients are able to mobilise fully at least 2-3 days after the operation with normal activities resuming within a week and driving can be attempted anytime from 2-3 weeks.
All the above choices are discussed with patients and surgery is guided by a mutual decision.
The main risks for any such repair includes, recurrence of the defect as well as ongoing abdominal pain as well as injury to underlying abdominal organs particularly bowel (intestines) and chronic abdominal pain. The risk of wound infection is higher with the open technique.
No heavy lifting is advised for at least 6 weeks after surgery.