Zhou Renpeng, Mao Xiyuan, Hou Yanping, Liang Yimin, Wang Danru
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China.
Department of Urology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, People's Republic of China.
Aesthetic Plast Surg. 2025 Sep 2. doi: 10.1007/s00266-025-05198-9.
Postpartum women often experience abdominal skin laxity and diastasis rectus abdominis. Lipoabdominoplasty, including anterior rectus sheath plication, is commonly performed to address these issues. However, excessive plication may increase intra-abdominal pressure (IAP) and postoperative pain, potentially causing complications. The relationship between plication width, IAP, and postoperative pain remains underexplored.
This study aimed to evaluate how plication width impacts IAP and postoperative pain in patients undergoing lipoabdominoplasty.
Thirty female patients underwent lipoabdominoplasty with plication of anterior rectus sheath in two-layer suture. IAP was continuously monitored using a urodynamic analysis system (Laborie) throughout the procedure. For analysis, IAP was specifically recorded before and after the plication of the anterior rectus sheath. Postoperative pain was assessed on postoperative day 1 (POD1) using the Numeric Rating Scale for Pain. Plication width, original rectus diastasis width, and corrected distance were recorded and analyzed.
Mean IAP increased significantly from 5.7 mmHg pre-plication to 9.3 mmHg post-plication (p < 0.05). Infraumbilical corrected distance (D3, 2.1±0.7 cm) showed the strongest correlation with increased IAP (R = 0.61) and postoperative pain (R = 0.5). No significant correlation was found between BMI, rectus diastasis, and pre-plication IAP. No patients exceeded IAP >12 mmHg. Minor complications occurred in 10% (3/30), including two seromas and one wound dehiscence.
Anterior rectus sheath plication during lipoabdominoplasty significantly increased IAP, with the infraumbilical corrected distance (D3) demonstrating the strongest influence. In our study cohort, maintaining D3≤3.6 cm (mean: 2.1 cm) consistently kept IAP below the 12 mmHg safety threshold while achieving optimal esthetic outcomes. Continuous intraoperative IAP monitoring provided an objective method for individualized plication tension adjustment. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
产后女性常出现腹部皮肤松弛和腹直肌分离。包括前直肌鞘折叠术在内的腹壁成形术常用于解决这些问题。然而，过度折叠可能会增加腹内压（IAP）和术后疼痛，进而可能引发并发症。折叠宽度、IAP和术后疼痛之间的关系仍未得到充分研究。
本研究旨在评估折叠宽度对接受腹壁成形术患者的IAP和术后疼痛的影响。
30例女性患者接受了两层缝合的前直肌鞘折叠腹壁成形术。在整个手术过程中，使用尿动力学分析系统（Laborie）持续监测IAP。为进行分析，特别记录了前直肌鞘折叠前后的IAP。术后第1天（POD1）使用数字疼痛评分量表评估术后疼痛。记录并分析折叠宽度、原始腹直肌分离宽度和校正距离。
平均IAP从折叠前的5.7 mmHg显著增加至折叠后的9.3 mmHg（p < 0.05）。脐下校正距离（D3，2.1±0.7 cm）与IAP升高（R = 0.61）和术后疼痛（R = 0.5）的相关性最强。未发现BMI、腹直肌分离与折叠前IAP之间存在显著相关性。没有患者的IAP超过12 mmHg。10%（3/30）的患者出现轻微并发症，包括2例血清肿和1例伤口裂开。
腹壁成形术中的前直肌鞘折叠显著增加了IAP，脐下校正距离（D3）的影响最为显著。在我们的研究队列中，保持D3≤3.6 cm（平均：2.1 cm）可始终将IAP维持在12 mmHg的安全阈值以下，同时实现最佳美学效果。术中持续监测IAP为个性化调整折叠张力提供了一种客观方法。证据等级IV 本刊要求作者为每篇文章指定证据等级。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266 。
