The Long-Term Durability of Plication of the Anterior Rectus Sheath Assessed by Ultrasonography
University Medical Center Utrecht, Utrecht, Utrecht, Netherlands Plastic & Reconstructive Surgery
(Impact Factor: 2.99).
06/2001; 107(6):1578-84. DOI: 10.1097/00006534-200105000-00046
The purpose of this study was to assess the long-term durability of a standard vertical plication of the anterior rectus sheath. For this purpose, 70 women who had undergone this procedure as part of an abdominoplasty were sent a questionnaire, their records were studied, and they were invited back to the clinic for an examination using ultrasound. A total of 63 patients returned the questionnaire, and 40 were willing to attend a follow-up consultation and ultrasound investigation. The presence of rectus diastasis was assessed by ultrasound (a real time scanner with a 7.5-MHz linear probe). The study showed that after a follow-up of 32 to 109 months (mean, 64 months), standard plication of the abdominal wall with absorbable material led to residual or recurrent diastasis in 40 percent of the patients. It also confirmed that vertical plication only is not enough to improve the waistline and may eventually lead to epigastric bulging.
Available from: Jean-Philippe Giot
- "L'intervention est courte et bien codifiée ; de ce fait, les deux équipes peuvent travailler ensemble harmonieusement et efficacement sans perte de temps. Bien entendu, le recul est encore insuffisant  pour en tirer des conclusions définitives et nous prévoyons de faire un nouveau bilan dans trois ans avec scanner de contrôle systématique pour toutes les patientes. "
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ABSTRACT: In 10 cases of abdominoplasty where an important rectus diastasis had to be corrected, we completed the plication of the rectus sheath included in a classical abdominoplasty with the laparoscopic positioning of an intraperitoneal prosthesis.
To assess the middle-term results of this technique and present its advantages and drawbacks.
Patients and method
Fifteen patients have been operated from 2007 to 2011 by two surgeon teams. Ten of them have accepted to be included in our survey.
All the patients said they were satisfied with their surgery. Four of them reported mild pain during the first postoperative weeks, and two of them mentioned very moderate pain at the time of the survey. The surgeons were not satisfied with the results obtained in two cases. Only one of these two patients accepted revision abdominoplasty with a good result.
Laparoscopic positioning of an intraperitoneal prosthesis, coupled with a classical plication of the rectus sheath, gives excellent results in difficult cases of rectus diastasis.
Annales de Chirurgie Plastique Esthétique 08/2012; 57(4). DOI:10.1016/j.anplas.2011.08.011 · 0.31 Impact Factor
- "The durability of diastasis repair has been well-documented. The effect of intra-abdominal fat content resulting in the protruded appearance after the surgery has been highlighted by only few authors. "
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ABSTRACT: Extensive liposuction along with limited dissection of abdominal flaps is slowly emerging as a well proven advantageous method over standard abdominoplasty.
A retrospective study analyzed 146 patients managed for the abdominal contour deformities from March 2004 to February 2010. A simple method to project the post operative outcome by rotation of a supine lateral photograph to upright posture in 46 patients prospectively has succeeded in projecting a predictable result. All patients were encouraged to practice chest physiotherapy in 'tummy tuck' position during the preoperative counseling. Aggressive liposuction of entire upper abdomen, a limited dissection in the midline, plication of diastasis of rectus whenever indicated, panniculectomy and neoumblicoplasty were done in all patients.
The patients had a mean age of 43, youngest being 29 and oldest 72 years. Majority were of normal weight (94%). Twelve were morbidly obese; 57 patients had undergone previous abdominal surgeries; 49 patients had associated hernias. Lipoabdominoplasty yielded a satisfactory result in 110 (94%) patients. The postoperative patient had a definitely less heavy harmonious abdomen with improved waistline. The complications were more with higher BMI, fat thickness of more than 7 cm and prolonged operating time when other procedures were combined.
Extensive liposuction combined with limited dissection method applied to all abdominoplasty patients yielded consistently safe, reliable and predictable aesthetic results with less complications and faster recovery. The simple photographic manipulation has helped project the postoperative outcome reliably. The preoperative chest physiotherapy in tummytuck position helped prevent chest complications.
Indian Journal of Plastic Surgery 03/2012; 45(1):77-88. DOI:10.4103/0970-0358.96592
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ABSTRACT: Liposuction abdominoplasty-liposuction of abdominal subcutaneous tissue deep and superficial to Scarpa's fascia, with excision of excess abdominal skin and, when indicated, plication of the anterior rectus sheath without undermining-is an effective, low-risk approach to minimizing abdominal flap undermining. The technique allows aggressive thinning and "sculpting" of full-thickness abdominal subcutaneous tissue and achieves a natural (not featureless) abdominal contour. It minimizes the creation of "dead space," which often leads to postoperative complications, as well as preserves sensory nerve and blood supply to the abdominal skin. The operation may be performed with the patient under local anesthesia, which probably diminishes the risk for deep vein thrombosis. Moreover, additional procedures can be conducted safely and the postoperative course is short, uneventful, and without restrictions; patients return to normal activity within a week or so. New evaluation criteria for abdominoplasty are discussed in this article, the most important of which is the assessment of intraabdominal fat content and its impact on surgical outcome and the decision to perform anterior rectus sheath plication. The concept of a sliding, mobile, sensate abdominal flap, created by liposuction and sustained by multiple neurovascular mesenteries, is also offered.
Plastic & Reconstructive Surgery 08/2003; 112(1):288-98; discussion 299-301. DOI:10.1097/01.PRS.0000066371.34978.F0 · 2.99 Impact Factor
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