Cosmetic
The unstable midline results in visible bulging under pressure. The abdominal circumference is increased, patients can look like they are pregnant again.
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Surgery for rectus diastasis
Rectus diastasis refers to an increased distance between the straight abdominal muscles. Although it can be found in men and women, especially women after pregnancy are often suffering from symptoms related to rectus diastasis. We have extensive experience in the surgical treatment of rectus diastasis with a very strong focus on minimally invasive techniques. With more than 50 procedures annually we are among the centers with the highest case numbers for the treatment of rectus diastasis.
What is rectus diastasis?
Rectus diastasis refers to a widened midline of the abdomen (linea alba). Our midline of the abdomen consists of fibrous tissue only and it serves as an attachment for the abdominal core muscles (straight, oblique and transverse muscles). Therefore it plays a key role in providing core stability. When this midline is widened to more than 2cm it is called rectus diastasis. With increasing with more symptoms can occur. Many patients suffer from lack of core stability while exercising, reduced rotational strength, increased lower back pain and impaired pelvic floor function, increased bloating and many more.
Minimally invasive surgery (TESLAR)
We offer a specialized minimally invasive surgical technique for the treatment of rectus diastasis. The TESLAR-Surgery (Total Endoscopic Linea Alba Repair) uses small incisions in the "Bikini-Zone" to achieve a complete reconstruction and reinforcement of the linea alba and concomitant hernias of the abdominal wall. With no other scars needed this surgery remains practically invisible, resulting in ideal cosmetic results. We have extensive experience with this technique, as it has been offered in our center since its development in 2013.
Open surgery (Abdominoplasty)
In patients with severe excessive skin after weight loss or after pregnancy an ideal cosmetic results can only be achieved by removing this excess in tissue. For these patients a minimally invasive technique is not sufficient and an open approach is more promising. In our center an abdominoplasty always includes complete reconstruction of the abdominal wall (closure of hernia defects, correction of the rectus diastasis, reinforcement with a mesh) to achieve not only a good cosmetic result but perfect functional outcome too.
Rectus diastasis
Our midline of the abdominal wall consists of fibrous tissue (linea alba) that serves as an attachment for the core muscles in the midline. No muscles cross this midline. It is therefore a possible weak spot, presenting with an increased risk for the formation of hernias (umbilical hernias, epigastric hernias) and it is prone to dilate under load. This load can be due to increased intraabdominal pressure in obesity with increased visceral fat or during pregnancy. When related to increased visceral fat it is mainly limited to the upper part of the abdomen. The distal part from the umbilicus downwards remains stable. As this keeps a part of the abdominal wall stable, most of these patients have no symptoms and are mainly bothered for cosmetic reasons (visible bulging).
The formation of a diastasis during pregnancy is a normal process to provide space for the growing child. After giving birth the resulting hormonal changes within the reconditioning phase (6 to 9 months after giving birth) result in closure of the midline in most cases. However it can remain enlarged in some patients. Risk factors for the development of a rectus diastasis after pregnancy include multiple pregnancies, high birth weight of the child or twin pregnancy.
A specific exercise training routine can improve the closure of the diastasis during the recondition phase after giving birth. However no further improvements can be expected after this time (6 to 9 months after giving birth) as the necessary hormones are no longer produced after this time. Altough a closure with training can not be achieved after this time, it is still beneficial to do those exercises. These result in better muscular function and control of the abdominal wall and therefore support an optimal functional outcome after surgery in any case.
Symptoms of rectus diastasis
Functional weakness
Core stability is impaired with reduced rotational strength, inability to retain good posture and an overall feeling of being unstable.
Pain
To achieve core stability our back and abdominal muscles must work in balance. Diastasis shifts that balance and an overload of our back muscles results, lading to lower back pain.
Pelvic floor function
Our pelvic floor muscles need a stable counter part to wirk effectively. When this is lacking, it is hard to train these muscles and reduced function can follow. Typical symptoms are urinary incontinence under stress.
Gastrointestinal
With no stable abdominal wall abdominal bloating can be significantly increased. Many patients report a significant reduction of bloating in general.
Goals of a surgery
Every surgery for rectus diastasis must achieve some central endpoints to ensure patient satisfaction. The main goal is the primary closure of the diastasis itself. Additionally any hernias must be treated within the same procedure resulting in a closed, stable and functional abdominal wall. A recurrence of hernias and the diastasis must be prevented over long term, not only for a couple of months or years. Possible complications and side effects must be kept minimal.
Minimally invasive surgery (TESLAR)
We are specialized in minimally invasive surgery for the treatment of rectus diastasis. Our preferred technique is the TESLAR surgery (Total Endoscopic Linea Alba Repair). This approach uses three small incisions within the "Bikin-Zone" and reconstructs the complete abdominal wall without scars in the visible part of the abdomen. The reconstruction of the abdominal wall is done with a running suture and additional mesh-reinforcement. This provides an excellent functional and cosmetic outcome and excellent long term results. We have offered this technique in our center since 2013, pioneering minimally invasive surgery in this field.
Which patients qualify for this technique?
All patients with a rectus diastasis might qualify for this surgery. However in patients with severe excessive skin an open approach might result in an overall better cosmetic outcome. Limitations exist in patients with very large hernias or high BMI with central obesity.
Are any preoperative examinations necessary?
The diagnosis of the diastasis and concomitant hernias can be made by clinical examination in almost all patients. Additional examinations (CT, Ultrasound) are only done in unclear situations or if further symptoms are present that are not linked to the diastasis or the hernia.
Where are the scars and how big are they?
We use three small incisions for this surgery. All are positioned in the "Bikini Zone" or within a c-section scar if present. The main incision in the midline measures 12-15mm, the other two incisions measure 5mm each. No additional incisions are needed.
How long does the surgery take?
In general the surgery takes approximately 45 minutes and it is performed in general anesthesia.
What if I had a previous surgery?
Former surgeries are not a problem and in most cases the surgery can be performed without adding any additional risks for the patient.
How long is the hospital stay?
Patients have to stay four to five days in the hospital. The is due to the placement of wound drains. These drains reduce the risk for seroma formation and can only be removed after sufficient reduction of liquid flow.
What complications are possible?
As with any other surgery general risks include bleeding, wound infection and thrombosis. These risk are absolutely minimal in this type of surgery. The only significant risk is the formation of a seroma (accumulation of wound liquid) that needs treatment with a punction. We have reduced the rate of this complication with different measures significantly to under 5% of patients that need to undergo a punction. As we do not enter the abdominal cavity the risk of bowel lesions is virtually inexistent.
How is the treatment and follow-up after hospital discharge?
All sutures are self dissolving and you can shower normally. Pain killers might be needed for the first 10 days after surgery. A compression belt must be worn 24/7 until the first control 2 weeks after surgery. From then on compression therapy continues with a body or the belt for 4 more weeks. Within this time physical activity can be increased gradually and the final control is scheduled 6 weeks post surgery.
When can I do sports again?
Light exercise (jogging, walking) can be started two weeks after surgery. Full sportive activity can be started 6 weeks after surgery. However we recommend to avoid crunches and situps for 6 months after surgery. Any other exercise including weight lifting is fine after 6 weeks.
Do I need physiotherapy after surgery?
No, there is no need for specific physiotherapy after surgery. You can restart with you normal exercise quite quickly.
Does the insurance cover this surgery?
In patients that have an umbilical or other hernias within the diastasis the surgery is covered in any case. In patients without a hernia an individual request to the insurance company has to be made.
Open surgery (Abdominoplasty)
An open surgery approach might be indicated in selected patients when they are not ideal for a minimally invasive approach. Mainly this is due to the presence of excessive skin. Patients that wish to correct not only the functional problems but also remove the excessive skin can achieve a better cosmetic result with an open approach. In minimally invasive techniques the skin remains more or less the same as before surgery. In an open approach we can remove this excessive skin. Depending on the individual situation the length of the incision can vary. We always position the incision as low in the "Bikini-Zone" as possible to achieve less visible scars. In any case the rectus diastasis and all present hernias are closed and reinforced with a mesh to achieve perfect functional outcomes.
Can the belly button be preserved?
Yes, in most cases the belly button can be preserved. It must be repositioned in most cases which leads to a scar around the umbilicus itself. In rare cases where the umbilicus has been detached completely due to a large umbilical hernia preservation might not be possible. In these cases a new belly button is formed to mimic a normal umbilicus.
Do you perform additional lipo suction?
No we do not perform or recommend simultaneous liposuction. This would increase the risk for postoperative complications significantly and might not achieve the desired result. If patients wish to perform an additional liposuction we recommend to do this only after a minimum of 9 months after surgery to ensure good wound healing.
Are the risks for complications higher compared to endoscopic surgery?
In general the risk and complications remain the same as in endoscopic surgery. Due to the greater length of the incisions the risk for wound dehiscence or wound infections is slightly elevated although still very low.
What about the postoperative follow-up?
The postoperative follow-up is identical to the endoscopic surgery.
Are the costs covered by the insurance?
In patients with hernias the costs for the reconstruction of the abdominal wall are covered by the insurance. However the additional removal of excessive skin is usually not covered and must be declared separately. A request for full coverage can always be sent to your insurance company. If the request is granted, full coverage will be provided by the insurance.
What are the additional or total costs?
The costs for the cosmetic part of the surgery (removal of the excessive skin) depends on the extent of the surgery and the hospital. Private insured patients can be operated at Hirslanden Klinik Im Park, all other patients can be operated at Seespital Horgen or Triemlispital. We will provide you with an individual offer during your consultation. All offers are always a fixed price and we do not charge any further costs afterwards.