Is it possible to do vertical plication and horizontal plication of the abdominal muscle wall?

Hi msantana0726,So the answer is yes and no. First, I don’t do laparoscopic diastasis repair. It is done under direct vision typically through a low transverse abdominoplasty incision. It can also be done through a midline incision (like a hernia) depending on the needs of the patient. Unfortunately, a midline incision is not a cosmetically appealing incision, so this is done purely from a functional standpoint, and to look better and clothes…..mostly on older males. With regards to doing both a vertical and horizontal plication. This really depends on the amount of laxity in the abdominal wall but there are times where I’ve done a vertical plication and still there’s a lot of lower abdominal laxity so I will add a horizontal repair. I always talk to patients about having visceral or intra-abdominal fat because if you have a lot of visceral fat, as males typically do, it makes it difficult to obtain a flat abdomen. Also, it makes the repair more prone to fail due to increased (intrabdominal) pressure on the repair.

For significant diastasis recti a surgeon can do multiple different vectors of plications to help tighten the muscles.
However because of my experience doing abdominal wall reconstruction prior to cosmetic surgery i rarely recommend the horizontal plication because it is countering all the natural force vectors of the body. What this means is every time you stand up you would be fighting the plicatiln and stretching it out with a very high chance of recurrence of that laxity in a short amount of time.
Instead i recommend plicating the midline and then doing additional plications just lateral to the rectus muscle to help take up extra laxity (medical term: plication of the semilunar line)

Diastasis recti is a condition in which the abdominal muscles separate, causing a bulge in the midline of the abdomen. Laparoscopic diastasis recti repair is a minimally invasive surgical procedure that involves using small incisions and a laparoscope to access the abdominal muscles and repair the separation.

During the procedure, the surgeon may perform a plication of the abdominal muscle wall, which involves folding the muscles back together and stitching them in place to reinforce the midline of the abdomen. The direction of the plication (vertical or horizontal) may depend on the extent and location of the muscle separation.

In some cases, both a vertical and horizontal plication may be performed to achieve the desired result. However, the specific surgical approach will depend on the individual patient's anatomy and the surgeon's preference and experience.

It's important to consult with a qualified and experienced surgeon to determine the best course of treatment for your specific condition.

I hope this helps,
Best of luck !