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Surgery Dr. Clement
Hernias after pregnancy
Different types of hernias can occur after pregnancies. Special attention must be paid to a possible rectus diastasis.
A so-called rectus diastasis refers to an increased distance between the muscle bellies of the straight abdominal muscles (Musclus rectus abdominis). It is more frequent after repeated pregnancies. A pronounced rectus diastasis has significant disease value and is not a cosmetic problem.
During pregnancy, the abdominal wall is greatly stretched for the space needed to accommodate the child. Depending on the stability of the connective tie of the abdominal wall, this can lead to the formation of a rectus diastasis, but also to the development of hernias. During pregnancy, the development of an umbilical hernia as well as inguinal or thigh hernias can be frequent. This is due to the increased intra-abdominal prere during pregnancy. After birth, the tie may partially regress. Although the actual hernia openings cannot close themselves even in this situation, the hernias are often small enough after birth that they remain asymptomatic. Due to the strong tensile forces on the connective tie during pregnancy, a widening of the connective tie bridge in the midline of the abdominal wall may occur. This so-called linea alba in the central axis of the abdominal wall consists only of connective tie. If this tie bridge is now pulled in width, the actual muscle bellies of the straight abdominal muscles (Musclus rectus abdominis) move to the side. This is called rectus diastasis. A low-grade rectus diastasis occurs very often and is usually asymptomatic. However, especially slim patients may notice a cosmetically disturbing bulge in the middle and upper abdomen when tightening the abdominal muscles. However, due to the change in the direction of the course, the functioning of the straight abdominal muscles is also affected. In the case of pronounced rectus diastases, this can be noticed by the patients in particular by increased trunk instability and back pain. The reason for this is that the abdominal muscles, as counterparts of the back muscles, are crucial for the stability of the trunk. An imbalance between these muscle groups quickly leads to discomfort. When there is a combination of rectus diastasis and umbilical or epigastric hernia, we make surgical care more difficult. The risk of hernia recurrence is greatly increased. Here a special expertise is necessary to achieve a correct reconstruction of the abdominal wall.
Reconstruction of the linea alba alone
A pronounced rectus diastasis can be very disturbing cosmetically. Much more important is the disturbance of the function of the abdominal wall. The associated trunk instability.
A pronounced rectus diastasis can be highly symptomatic. In many cases, therefore, reconstruction of the linear alba with correction of the rectus diastasis is indicated. The goal of surgery is a complete reconstruction of the linea alba. So that a restoration of the physiological anatomy. There are different possibilities of reconstruction. Often a simple adaptation by suturing is performed. Since a large scar must often be accepted and the simple suture also carries a relatively high risk of recurrence (tearing of the suture and renewed formation of a rectus diastasis), this is not an optimal treatment. With the aim of achieving an optimal reconstruction of the linea alba while achieving an optimal cosmetic and functional result, Dr. Kukleta developed a total endoscopic operation. The operation is performed endoscopically through a small access inside the abdominal wall. The linea alba is reconstructed along its entire length. Reinforced with a mesh to prevent recurrences. Due to the preparation inside the abdominal wall, the mesh is placed outside the abdominal cavity. This prevents the development of adhesions. Massively reduces postoperative pain. At the end of the operation only two 5mm and one 12mm incisions remain which are approximately in the same area as a caesarean section scar.
Reconstruction of the linea alba in hernias
In many cases an umbilical or epigastric hernia is present in addition to the rectus diastasis. In these cases the operation has to treat both pathologies at the same time.
In case of a combination of a hernia and rectus diastasis, the surgical treatment must take both pathologies into account in order to achieve an optimal result. A pure treatment of the hernia by direct suturing also involves a very high risk of recurrence in the case of small hernia gaps in this situation. An open treatment with mesh insertion results in a cosmetically unsatisfactory result with a large, visible scar. In the case of laparoscopic mesh reinforcement (IPOM), there is a considerable risk of adhesions in the abdominal cavity (risk of intestinal obstruction), in addition, very severe pain can occur which can also last for a long time. In addition, this procedure does not correct the cosmetically disturbing protrusion caused by the rectus diastasis, nor does it affect the functional disorders caused by the displacement of the muscles. Basically, the same procedure is used as for the pure linea alba reconstruction. In addition, however, the hernia gaps are completely exposed, the hernias reduced and the gaps closed. The mesh reinforcement is chosen in such a way that all hernia gaps are widely covered and also the rectus diastasis suture is sufficiently reinforced. This operation is also performed completely endoscopically through the same accesses. By fixation of the mesh with a special tie adhesive, a painful fixation with staples can be avoided (typical for IPOM). Due to the minimally invasive treatment, you benefit from an optimal cosmetic result without having to accept an increased risk of recurrences. Sports activities after healing are not limited in any way.
Both in the case of a pure rectus diastasis and in the case of a simultaneously present hernia within the diastasis, a complete reconstruction of the anatomy of the abdominal wall is performed. The linea alba is tightened with sutures, which causes the rectus muscles to move back towards the midline. Any hernia gaps are additionally closed in the process. Subsequently, the reconstruction is permanently reinforced by inserting a mesh.
The linea alba is widened, the rectus musculature is displaced to the side.
Hernia in a rectus diastasis
Within the widened linea alba an additional hernia is present. This represents an opening of the abdominal wall, the connective tie is interrupted here.
Condition after surgery
The rectus muscles are correctly positioned in the midline again. The linea alba is reconstructed. The overlying mesh reinforces the abdominal wall and prevents recurrence. In this TeleZuri CheckUp program on the subject of rectus diastasis. Hernia after pregnancy we inform about the minimally invasive treatment options. Our patient gives information about the complaints. For recovery after surgery.