The vertical suture of the rectus abdominis sheaths was stronger than the horizontal suture because of the more transversal arrangement of its aponeurotic fibers. Thus, routine use of the vertical suture in plications of the aponeurosis of the rectus abdominis muscles is suggested.
Http://www.ncbi.nlm.nih.gov/pubmed/21556988
And is mash insertion indicated to prevent this?
Diastasis recti is a variant of normal anatomy and has no pathologic implications (even if some aesthetic surgeons claim the opposite, for the benefit of their businesses...).
If fascia closure is performed lege artis (see the works of Leif Israelsson and his group), in normal patients there is no need for mesh reinforcement.
Yes that is also my opinion. The idea for the question came to me after the data that significant percatage of incisional hernias after right subcostal incision develop in the most medial part.
If the diastasis is large,anatomical repair with an onlay mesh repair is better to reinforce the repair.we found more incisional hernias laterally than medially with Right subcostal incision.The possible explanation is that we start closing from medial to lateral and even if a small area was not included in the suture that is a potentially a weak spot.
I agree. We start closing abdominal wall from lateral to medial. That is the reason for more medially located postoperative hernias. I currently start with the loop suture from both sides.
I our set up diastasis of recti is common with-multiparty ladies and we generally do mesh strengthening .Abdominal wall is weak due to multiparty .
Khalid, do you want to say that when you do subcostal incision in a multiparity women with diastasis recti you always put a mesh. In what position: 1) epifascially, 2) intraperitoneally. And over the whole incision or only over medial aspect where diastasis recti is.
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