When exercise doesn't help anymore
Diastasis is the divergence of the rectus abdominis muscles to the sides with stretching of the connective tissue bridge between them. Most often it occurs after pregnancy, especially multiple and repeated ones, as well as with severe obesity. It manifests itself as protrusion in the midline when tense, a feeling of weakness in the abdominal muscles, lower back pain and poor posture.
The width of the divergence determines the tactics. For diastasis up to 3 centimeters, the basis of treatment is properly selected physical activity: exercises on the deep core muscles and transverse abdominal muscles with the obligatory exclusion of classic crunches and sagging planks, which increase the discrepancy. With a width of 3 to 5 centimeters, the result of the exercises is partial; above 5 centimeters, the stretched aponeurotic bridge does not contract on its own, and it has to be sutured.
The operation involves suturing the edges of the rectus muscles along the midline, often reinforced with a mesh implant. It can be performed openly, often in combination with abdominoplasty if there is excess skin, or endoscopically through small punctures - without a large incision and with a quick recovery. Diastasis is often combined with an umbilical hernia, and both conditions are eliminated simultaneously. Intervention should be planned no earlier than one year after birth and after completion of breastfeeding.
Advantages of laparoscopic approach
Instead of a 10–20 centimeter long incision, 3–4 punctures ranging in size from 5 to 12 millimeters are made. This reduces pain after surgery, reduces the need for painkillers, speeds up the recovery of bowel function and allows you to be discharged much earlier.
The cosmetic result is no less important: puncture marks become almost invisible over time. The incidence of postoperative hernias and adhesions is also reduced, since the abdominal wall and internal organs are less injured.
When laparoscopy is not possible
Limitations include a pronounced adhesive process after previous operations, severe heart and lung diseases in which the injection of gas into the abdominal cavity is poorly tolerated, blood clotting disorders and extreme obesity.
Sometimes the decision is made already during the operation: if the anatomy does not allow working safely, the surgeon switches to an open approach. This is not a complication, but a provided option, about which the patient is warned in advance.
What happens after discharge
In the first weeks, fractional meals, sufficient amounts of fluid and a gradual expansion of the motor regime are recommended. Heavy loads, saunas and swimming pools are avoided until healing.
Reasons to immediately consult a doctor include fever, increasing abdominal pain, redness and discharge from punctures, nausea and vomiting, retention of stool and gas.