Bracale Umberto, Stabilini Cesare, Cavallaro Giuseppe, Pecchini Francesca, Sarno Gerardo, Agresta Ferdinando, Carlucci Michele, Rocchetti Simona, Sartori Alberto, Di Leo Alberto, Andreuccetti Jacopo, Pignata Giusto, Tartaglia Ernesto, Sagnelli Carlo, Cuccurullo Diego, Iossa Angelo, Vettoretto Nereo, Lionetti Ruggiero, Bertoglio Camillo, Confalonieri Marco, Testini Mario, Soliani Giorgio, Galatioto Christian, Crucitti Antonio, Piccoli Micaela, Formisano Giampaolo, Iacone Biancamaria, Aiolfi Alberto, Procida Giuseppa, Montori Giulia, Tramontano Salvatore, Balla Andrea, Giovannini Sara Capoccia, Cavalli Marta, Campanelli Giampiero, Podda Mauro
Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Department of Integrated Surgical and Diagnostic Sciences, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Hernia. 2025 Jun 27;29(1):213. doi: 10.1007/s10029-025-03403-x.
Rectus Abdominis diastasis (RAD) is a prevalent condition, particularly in post-gravidic women, with functional and esthetic impact. This Delphi consensus, led by general surgeons, aimed to establish evidence-based recommendations for the diagnosis and management of RAD in post-gravidic women.
A Delphi process was conducted under the auspices of the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS), the national chapter of the European Hernia Society (EHS). A steering committee supervised systematic literature reviews to evaluate the quality of evidence and formulate recommendations. Iterative rounds of voting involving 105 expert panellists were conducted, with Consensus defined as ≥ 70% agreement. Non-consensual recommendations were revised and discussed in a plenary session during the Italian Society of Surgery (SIC) Congress, 2024.
Consensus was achieved on 12 recommendations covering RAD diagnosis, classification, and treatment. Key findings included the endorsement of radiological methods for accurate RAD assessment, the establishment of surgical thresholds (> 2.5 cm inter-recti distance for symptom improvement), and the recommendation of minimally invasive linea alba plication for surgical management. Non-operative treatments, such as targeted exercise programs, were emphasized as first-line approaches. For RAD with concomitant hernias of the linea alba with defects > 1 cm, mesh reinforcement was strongly recommended, with extraperitoneal placement preferred. The importance of tailoring approaches based on patient-specific factors and fostering shared decision-making was highlighted.
This consensus provides a structured framework for RAD management, emphasizing accurate diagnosis, tailored treatments, and patient-centered care. Future multicenter studies are required to address remaining evidence gaps and refine these recommendations.
腹直肌分离（RAD）是一种常见病症，尤其在产后女性中，会对功能和美观产生影响。这项由普通外科医生主导的德尔菲共识旨在为产后女性RAD的诊断和管理制定基于证据的建议。
在欧洲疝学会（EHS）的意大利分会——意大利疝与腹壁外科学会（ISHAWS）的支持下开展了德尔菲流程。一个指导委员会监督系统的文献综述，以评估证据质量并制定建议。对105名专家小组成员进行了多轮投票，共识定义为≥70%的同意率。在2024年意大利外科学会（SIC）大会的全体会议上，对未达成共识的建议进行了修订和讨论。
就涵盖RAD诊断、分类和治疗的12项建议达成了共识。主要发现包括认可采用放射学方法进行准确的RAD评估、确定手术阈值（腹直肌间距>2.5 cm以改善症状），以及推荐采用微创白线折叠术进行手术管理。强调将非手术治疗，如针对性的运动计划，作为一线方法。对于伴有白线疝且缺损>1 cm的RAD，强烈推荐使用补片加强，优先选择腹膜外放置。强调了根据患者特定因素调整治疗方法以及促进共同决策的重要性。
这一共识为RAD管理提供了一个结构化框架，强调准确诊断、个性化治疗和以患者为中心的护理。未来需要开展多中心研究以解决尚存的证据空白并完善这些建议。
