Laparoscopic repairs of hernias and diastasis recti work the same way: the surgeon tacks a mesh on either side of the weak area, essentially creating a barrier which prevents bowels from coming through the muscle wall (hernia) or putting pressure (diastasis) on the weak area. This is a terrible idea for a diastasis, because THE MUSCLE IS NOT BROUGHT TOGETHER AT ALL. Yes, it is just left in the same way it is now, although it may help it from spreading further. For my patients, they want the muscles together again, and tight. Like they were prior to pregnancy. This must be done from the front. The diastasis repair can be done through a Pfannansteil (Csection) incision, if the plastic surgeon know how to do that (most don't so make sure you ask). Also, if you were to repair the muscle from the inside, the skin would bunch together in the midline very badly, and the surgeon would have to go around to the front and undermine the skin and fix it from the front anyway. So don't even try to fix it from the back, it's ineffective, at best. I bet your doctor is not plastic surgeon?!
Every surgeon has their techniques and approaches that work for them. I believe diastasis repair is a fairly common procedure and most surgeons would repair it via a traditional approach of placing a row of sutures from the xiphoid all the way down to the pubis. This is what is generally done during a tummy tuck.
However, it is apparent that you do not need a tummy tuck or any skin excision. The way your diastasis can be repair and it would be more predictable without the use of mesh, would be to place an incision down low were a C-section incision would be and to also place an incision around the umbilicus. The entire repair can be down thru these incisions.
Hope that helps. Make sure you are also seeing a board certified plastic surgeon.
Thank you for the question and photos. You may want to consider an endoscopic tummy tuck where the muscles are brought back together (similarly done to a full tummy tuck) but the surgery is done through a small incision near your pubic bone and one inside your belly button. The link below shows one of my endoscopic tummy tuck patients who had a c-section scar where the endoscopic tummy tuck was done through.
All the best,
Dr. Remus Repta
Diastasis repair surgery laparoscopically with mesh and four sutures does not seem like enough sutures to keep my muscles together and looking nice and tight.
I look at laparoscopic techniques to correct a rectus diastasis with skepticism. I am familiar with attempts to perform these repairs, but have yet to see any worthwhile results using thus method.
Your lower abdominal skin is not excessive. The success of diastasis repair depends on multiple factors, and there are many different surgeon preferences with mesh, technique and sutures. Surgeons don't typically discuss how many sutures they plan to use for a procedure. 4 sutures could mean 4 tacks or 4 x 30cm running sutures. You should discuss the proposed procedure with your surgeon in more detail, and his level of experience using the technique to fix this problem.
This sounds like a general surgeon would be performing the diastasis recti repair? If insurance is paying for this procedure then this is probably your only option.. This will not give the best cosmetic result but a traditional tummy tuck with rectus diastasis repair would not be covered by insurance. Good luck
I would likely use many more sutures to repair the laxity given the appearance in the pictures. I think that if you want to be as tight as possible, some skin should be removed as well. Tightening the abdominal wall reduces its surface area, and the skin surface area should be reduced as well.
Kenneth Hughes, MD
Los Angeles, CA
Surgeons vary in their approach based on personal experience and comfort level. However, traditional approach tends to provide a more predictable outcome and is practiced by most plastic surgeons.
In your case, I do not think a mesh will be necessary bearing in mind the inherent issues that it may pose down the line.
It may not also hurt to seek more than one consultation prior making your final decision.
I would never pre-operatively decide how many sutures to place to repair a diastasis recti. You place what the patient needs. I do think that for the length of diastasis you have that 4 sutures seems like a small amount.