Due to a second recurrent diastasis, my surgeon is leaning towards endoscopic surgery to retighten the diastasis this time, instead of opening me up again. I think an ultrapro mesh overlay may be needed for the best reinforcement and the best chance of success. Can the mesh support be used endoscopically? Will both above and below umbilicus be effectively re-tightened endoscopically? Will there be any difference in the look or tightness when done endoscopically as opposed to traditional surgery?
Better Results from Endoscopic Diastasis Repair?
Doctor Answers 3
Mesh probably not needed...
Many surgeons use a running suture to repair the diastasis during an abdominoplasty (myself included). The only problem is that if you have a fall after surgery or have a lot of vomiting, the suture may break and then the whole thing comes undone. My approach to that is to re-elevate the flaps and use interrupted sutures the second time around. If your surgeon can do that endoscopically, then that's fine, but I don't think the mesh is needed. Just don't fall again!
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Endoscopic diastasis repair can be difficult
Although it is possible to correct a diastasis repair with endoscopic techniques, this is a very difficult surgery, especially in a recurrent case. When performing endoscopic surgery, the surgeon is working in a limited area and with limited vision. This can make even an initial repair difficult, much less an area that has already failed the first repair. For a difficult diastasis repair you would best be served by revising this repair under direct vision and with full exposure.
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Endoscopic diastasis repair after disruption
Thank you for the pictures. It is often impossible to answer some of the questions posed to us by others without any visual data.
1. Are we to understand that "second recurrent diastasis" means you disrupted your diastasis repair TWICE? (recurrent being the first time and the fall being the second?
2. If so, how was your diastasis repaired the first time by your surgeon?
Frankly, I am bothered by the breakdown (or repeated breakdown) of your diastasis repair since it implies that your muscle lining which holds the sutures (the fascia) was either weak or attenuated and/or the (single) suture used was ONLY placed in a running fashion (in which case ANY break in the suture would result in recreation of the separation), or BOTH. Personally, while using a single suture is preferred by some, to prevent exactly such complications, I like to use BOTH multiple, interrupted sutures.
Unless you have a really weak, poor fascia, I see NO need for placement of an artificial mesh. It will only introduce another set of potential mesh related complications such as infection, seromas etc.
As regards to the suggested endoscopic approach, every surgeon must use his/her best judgment and the technique he/she thinks would best solve a problem. I like the open approach because of the visibility it provides and unmatched versatility in suture placement.
One last comment, I would advise you to wait as long as you can to get this corrected. The tissues need to be soft and free of inflammation. If we are forced to operate on inf lammed tissues, we always encounter a lot more bleeding, less than best visibility, less than normal tissue mobility, sutures pulling through and prolonged drainage after surgery.
I Hope this was helpful.
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