DIASTASIS RECTI ABDOMINIS: PROBLEMS OF DIAGNOSIS AND TREATMENT OF FALSE HERNIA

Abstract

Diastasis recti abdominis (DRA) is a pathological state characterized by thinning and stretching of the aponeurotic plate of the white line. In the neglected cases, the entire muscular-aponeurotic skeleton of the anterior abdominal wall, up to the Spigelian line, sticks out and bulges. DRA is an urgent problem of modern surgery. Its management and treatment takes much time and effort. The literature review analyzes the main causes and risk factors of DRA, and describes its pathogenesis in detail. Particular attention is paid to diagnostic methods. A number of classifications are considered depending on diastasis etiology, localization and degree. It is shown that diastasis diagnosis is based on a thorough history, patient’s complaints, and clinical examinations. Ultrasonography, computed tomography, and magnetic resonance imaging should be performed when a concomitant umbilical or epigastric hernia or other reason for the patient’s symptoms cannot be ruled out. The authors describe practical methods for DRA surgical management. They evaluate the efficacy of various treatment modalities and the results of treating patients with DRA. It is noted that optimal surgical management for DRA correction has not been found yet. However, there is no treatment modality, which suggests an operation without general anesthesia. Any surgical intervention for DRA management implies the use of combined endotracheal anesthesia. Choosing a surgery for DRA management, the surgeon should take into account the patient’s opinion on the method of surgical assistance, minimize the period of hospital treatment if possible, use reliable techniques, ensure a patient’s quick recovery with a maximum cosmetic effect and minimum complications.