Methods of restoring the white line of the abdomen during abdominoplasty (advantages and disadvantages)

Introduction. The pathology of the muscular-aponeurotic apparatus of the anterior abdominal wall is progressively increasing. Despite the significant prevalence of this pathology among men and women, accurate statistical data do not exist. This is partly due to the fact that rectus muscle diastasis is not considered a true hernia. In plastic surgery, the restoration of the white line during abdominoplasty is one of the primary tasks.
The purpose of the work: based on the data from clinical studies, to consider the disadvantages and advantages of various methods of diastasis of the rectus abdominis during abdominoplasty.
Materials and methods. The retrospective single-center study included 63 patients who underwent abdominoplasty to eliminate diastasis of the rectus abdominis at the clinical base of the Krasnoyarsk State Medical University named after Prof. V. F. Voino-Yasenetsky of the Ministry of Health of the Russian Federation from 2021 to 2024.
Results. Depending on the method of correction of breast cancer, the time spent on the operation varied. The most time-consuming operation was abdominoplasty with implantation of a fixed mesh endoprosthesis. The number of postoperative complications is the same in groups 1 and 3. However, in group 1, eruption of sutures naturally prevails. The number of gray is higher in the 2nd group. In group 3, 2 patients had partial dislocation of the mesh implant. Two clinical cases are given as an illustration.
Discussion. Suturing the diastasis with a wrapping suture reduces the risk of developing hematomas, seromas, and suppuration of the postoperative wound. Mesh prosthetic surgery increases the percentage of hematomas and gray matter. Plastic surgery with a mesh prosthesis without fixation significantly reduces the level of pain, but it is dangerous to dislocate the implant.
Conclusion. Each of the considered methods of breast plastic surgery has both advantages and disadvantages. The choice of method should be justified individually, taking into account all the data of the patient's preoperative examination.

1. Cavalli M., Aiolfi A., Bruni P.G., Manfredini L., Lombardo F., Bonfanti M.T., Bona D., Campanelli G. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia, 2021, Aug; № 25(4), рр. 883–890. https://doi.org/10.1007/s10029-021-02468-8

2. Karapetyan G.E., Pakhomova R.A., Kochetova L.V., Harutyunyan G.A., Ivkin E.V. Historical aspects of the development of methods of "strengthening" aponeurosis in abdominoplasty. Moscow Surgical Journal, 2021, № 2, pp. 87–93.

3. Belokonev V.I., Zakharov V.P., Grachev D.B. et al. Optimization of surgical treatment of abdominal hernias in obese patients. Bulletin of Surgery named after I. I. Grekov, 2021, vol. 180, № 1, pp. 73–80. (In Russ.)

4. Sergatsky K.I., Nikolsky V.I., Titova E.V. and others. Diastasis of the rectus abdominis muscles: the true issues of diagnosis and treatment of a non-true hernia. Ulyanovsk Medical and Biological Journal, 2022. No. 2. pp. 22-37. (In Russ.)

5. Adamyan R.T., Velikhanov R.R., G.E. Dashtoyan Surgical aspects of treatment of hernias of the anterior abdominal wall in combination with abdominoptosis. Plastic Surgery and Aesthetic Medicine, 2019, № 4, pp. 50–53. (In Russ.)

6. Timerbulatov M.V., Shornina A.S., Likhter R.A. and others. Correction of the anterior abdominal wall in patients with ventral hernia of median localization. Creative Surgery and Oncology, 2022, vol. 12, № 4, pp. 301–307. (In Russ.)

7. Yurasov A.V., Rakintsev V.S., Dubrov V.E. Endoscopic extraperitoneal reconstruction in primary median hernias on the background of diastasis of the rectus abdominis. Clinical and experimental surgery. The Journal named after Academician B. V. Petrovsky, 2022, vol. 10, № 1, pp. 65–71. (In Russ.)

8. ElHawary H., Abdelhamid K., Meng F., Janis J.E. A comprehensive, evidencebased literature review of the surgical treatment of rectus diastasis. Plast Reconstr Surg., 2020, vol. 146, № 5, рр. 1151–1164.

9. Azimov R.H., Gorsky V.A., Vlasov A.P. The process of tissue healing in allogernoplasty using various plastic materials in overweight patients. Ulyanovsk Medical and Biological Journal, 2022, № 4, pp. 66–73. 10. (In Russ.)

10. Matveev N.L., Makarov S.A., Kupriyanova A.S., Armashov V.P. Modern synthetic implants in reconstructive surgery of the abdominal wall. Bulletin of the Medical Institute "REAVIZ": rehabilitation, doctor and health, 2020, № 3, pp. 66–73. (In Russ.)

11. Shinde P.H., Chakravarthy V., Karvande R. et al. A Novel Modification of Subcutaneous Onlay Endoscopic Repair of Midline Ventral Hernias With Diastasis Recti: An Indian Experience. Cureus, 2022, vol. 14, № 6, рр. e26004.

12. Saiding Q., Chen Y., Wang J. et al. Abdominal wall hernia repair: From prosthetic meshes to smart materials. Mater.Today Bio., 2023, № 21, рр. 100691.