From the Division of Plastic and Reconstructive Surgery, McGill University Health Centre; the Faculty of Medicine, McGill University; and the Department of Plastic Surgery, The Ohio State University Wexner Medical Center.
Plast Reconstr Surg. 2020 Nov;146(5):1151-1164. doi: 10.1097/PRS.0000000000007252.
Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy.
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy.
Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability.
Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.
腹直肌分离是一种常见的病症，可导致腹部突出，造成外观和功能障碍。虽然腹直肌分离通常在腹部整形术或疝修补术中修复，但在修复指征和最佳手术技术方面缺乏共识。本研究的目的是提供腹直肌分离修复手术技术的最新综述及其比较疗效。
根据系统评价和荟萃分析的首选报告项目，检索了讨论腹直肌分离手术治疗并报告手术结果、并发症或复发率的 PubMed、Embase 和 Cochrane 数据库的文章。提取详细描述手术技术的数据，并对并发症和复发率进行汇总分析，同时控制手术方法、常见技术变化和相关疝修补术。
共纳入 37 项研究，描述了 45 种技术。其中 24 项研究采用开放腹直肌分离修复术。在控制相关疝修补术的情况下，开放与腹腔镜方法在手术并发症和复发率方面无统计学差异（p = 0.165 和 p = 0.133）。虽然双层缝合闭合与并发症发生率显著降低相关（p = 0.002），但缝合材料的可吸收性无显著差异。
通过开放和腹腔镜方法修复腹直肌分离是安全有效的。尽管缝合材料的可吸收性不影响并发症或复发率，但双层缝合闭合可以减少手术并发症。并发症和复发率的汇总分析有助于提高知情同意和患者教育。
