European Hernia Society guidelines on management of rectus diastasis. Issue 10 (1st October 2021)

• Record Type: Journal Article
• Authors: Hernández-Granados, P; Henriksen, N A; Berrevoet, F; Cuccurullo, D; López-Cano, M; Nienhuijs, S; Ross, D; Montgomery, A
• Is Part Of: British journal of surgery. Volume 108:Issue 10(2021)
• Page Start: 1189
• Page End: 1191
• Publication Date: 2021-10-01
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab128
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. Method: The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. Results: Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. Conclusion: RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested. Lay Summary: The management of RD is controversial. These guidelines are intended to provide a consensus about the exact definition, the correct way of measurement and diagnosis, a classification system, the main symptoms, and a systematic review of non-surgical and surgical treatments to achieve the best results for patients with this pathology. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is proposed. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD in those with concomitant midline hernias. Abstract : The European Hernia Society has decided to develop a Clinical Practice Guideline in order to optimize the management of rectus diastasis patients. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. The main recommendation is to define rectus diastasis as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, post pregnancy status and whether there is a concomitant hernia or not. Physiotherapy may be considered prior to surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of rectus diastasis with concomitant midline hernias