RESUMO
BACKGROUND: Women with multiple pregnancies often experience abdominal protrusion and/or a lax abdominal wall. Various open surgical techniques have been developed to address rectus diastasis in abdominoplasty, ranging from suture plication to mesh reinforcement. This study aims to compare the clinical and radiological changes between traditional abdominal plication and the addition of non-absorbable mesh for rectus muscle (RM) diastasis repair in terms of function, postoperative outcome, and recurrence. PATIENTS AND METHOD: This prospective retrospective study involved 63 women who underwent cosmetic tummy tuck surgery and met certain eligibility criteria. Patients with only mild diastasis recti, midline hernia, contraindications for major surgery, recent smoking history, or refusal of mesh augmentation were excluded. Clinical examination for abdominal protrusion or bulging and CT imaging was performed to check for recurrence of diastasis recti. The study included 33 patients who underwent mesh repair and 30 who underwent traditional abdominal plication. Follow-up was conducted after 1 year using CT and a questionnaire to assess various factors compared to preoperative measurements, with overall satisfaction rated on a 10-point Likert scale. RESULTS: There was no significant difference in demographic data between the two groups. Patients who underwent mesh repair had a slightly longer hospital stay and drain duration. The average waist circumference decreased in both groups without any statistically significant difference. Objective CT showed significant reductions in both groups in inter-rectus distance, RM width and circumference, and intra-abdominal circumference compared to preoperative values. All patients expressed satisfaction with scar quality and umbilicus aesthetics, and no recurrence was detected either clinically or radiologically during the follow-up period. CONCLUSION: Comprehensive preoperative assessment and imaging techniques like ultrasound and CT scans allow surgeons to detect postpartum changes in the abdominal wall. Mesh reinforcement may be indicated for diastasis above 4 cm in obese multiparous females. Thorough preoperative evaluation permits customized surgical plans to optimally restore abdominal wall anatomy and function. 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 at www.springer.com/00266 .
RESUMO
BACKGROUND: Abdominal contouring is a common procedure after bariatric surgery, but few studies on its outcomes have been conducted. The authors measured surgical and functional outcomes after postbariatric abdominal contouring and their effects on quality of life. METHODS: Thirty patients, male and female, of different age groups, underwent postbariatric abdominal contouring using traditional abdominoplasty, fleur-de-lis abdominoplasty, or belt lipectomy. The technical approach was decided according to each patient's presentation regarding the amount and extent of skin redundancy. All patients were given a booklet containing simplified questionnaires to assess quality of life and appearance to fill out both before and 6 months after the procedure. Data were collected face-to-face at the outpatient clinic during follow-up, by e-mail, or by messaging. RESULTS: The authors performed traditional abdominoplasty (seven cases), fleur-de-lis abdominoplasty (eight cases), or belt lipectomy (15 cases). Surgical outcomes (operative time, resection weight, blood transfusion, postoperative hemoglobin level, postoperative albumin level, hospital stay, drain period, and complications) were influenced significantly by the procedure type ( p ≤ 0.01). Health-related quality-of-life and appearance scale scores changed significantly from the precontouring stage to the postcontouring stage. This significant change in functional outcome was not correlated to the technical approach. CONCLUSION: Abdominal contouring surgery improves quality of life after bariatric surgery irrespective of the procedure type. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
