Surgery Versus Non-surgery Interventions on Rectus Abdominis Diastasis With or Without Hernias: a Systematic Review

Rectus abdominis diastasis is a common pathology and an esthetic and symptomatic problem; its reconstruction, either through a surgical strategy, standard vertical plication, or endoscopic surgery with or without mesh or through non-surgical physical training, is under debate. This study further aimed to compare the results of surgery and non-surgery interventions in cases with rectus abdominis diastasis. A systematic literature search of PubMed, Embase, and the Cochrane Library databases from the earliest data available to November 2018 was performed. Studies assessing symptomatic relief, adverse events, or symptomatic recurrence after surgery or a physical training program were included. A modified Downs and Black checklist for randomized and non-randomized studies of healthcare interventions was used to evaluate the methodological quality of the studies. Of 3908 citations, there were 27 studies with a total of 2372 patients finally being included in this study. In the surgery group, there was no patient relapsed after a follow-up of 12 months, while a 40% recurrence rate was reported after a follow-up of 5 years in one study. The adverse events associated with surgery mainly included seroma (5.13%), a sensibility disorder of the abdominal skin (2.26%), and minor scarring (1.56%). There were no adverse events or reports of recurrence in patients with physical training; however, negative effects of improving rectus muscle function were reported in 4 studies (40%). In conclusion, this review found a limited strength of evidence that abdominoplasty and diastasis recti repair were effective at restoring the functions of the rectus muscles and at improving the stability of the abdominal wall and quality of life in the short-term. A moderate strength of evidence was found that strength training has a limited effect, especially for patients suffering from rectus abdominis diastasis combined with a hernia.