Rectus diastasis is a condition characterized by a separation of the rectus abdominis muscles along the linea alba, typically more than 2 cm. It often develops after multiple pregnancies, obesity, or conditions leading to increased intra-abdominal pressure. While rectus diastasis alone is not a true hernia and rarely causes bowel complications, it can be associated with incisional or umbilical hernias, particularly in patients with a history of abdominal surgery. When these hernias coexist, they compromise both abdominal wall strength and function, leading to bulging, pain, and cosmetic concerns.

With advances in minimally invasive surgery, laparoscopic repair of rectus diastasis with incisional hernia has emerged as a safe, effective, and cosmetically superior approach compared to traditional open surgery. It allows for accurate hernia repair, midline reconstruction, and reinforcement with mesh, offering durable outcomes with minimal morbidity.

Introduction

Patients with rectus diastasis and associated incisional hernias present with:

Visible midline bulging, especially on straining or standing.

Discomfort or pain around the surgical scar or umbilicus.

Cosmetic concerns due to abdominal wall deformity.

Functional impairment, including reduced core strength or back pain.

While physiotherapy and core strengthening exercises may help in mild diastasis, surgical correction is indicated when hernias are present, symptoms are significant, or cosmetic results are a priority.

Indications for Laparoscopic Repair

Symptomatic incisional hernia with associated rectus diastasis.

Large bulge affecting abdominal wall function.

Cosmetic dissatisfaction in patients motivated for repair.

Recurrent hernia after previous open repair.

Obese patients, in whom open surgery has higher wound morbidity.

Contraindications include uncontrolled comorbidities, severe cardiopulmonary disease precluding general anesthesia, or very large defects requiring component separation.

Preoperative Evaluation

A structured preoperative workup is essential:

Physical examination to assess defect size, reducibility, and muscle separation.

Imaging studies (ultrasound or CT scan) to evaluate diastasis width, hernia contents, and abdominal wall anatomy.

Optimization of comorbidities like diabetes, hypertension, or obesity.

Smoking cessation to improve wound healing.

Patient counseling regarding the procedure, mesh reinforcement, and expected recovery.

Surgical Technique

Dr. R. K. Mishra and other experts emphasize a stepwise laparoscopic approach to achieve both functional and aesthetic restoration of the abdominal wall.

Anesthesia and Positioning

The procedure is performed under general anesthesia.

The patient is placed in a supine position, with arms tucked and slight Trendelenburg tilt for optimal exposure.

Port Placement

Pneumoperitoneum is established using a Veress needle or open entry.

A 10 mm camera port is inserted away from the hernia site.

Two or three 5 mm working ports are placed laterally for triangulation.

Hernia Content Reduction

Adhesiolysis is performed to free bowel or omentum adherent to the hernia sac.

Hernia contents are carefully reduced into the abdominal cavity.

Defect and Diastasis Identification

The incisional hernia defect and rectus diastasis are clearly visualized.

The linea alba is assessed for separation length and width.

Midline Closure

Using laparoscopic suturing, the hernia defect and rectus diastasis are approximated with non-absorbable or slowly absorbable barbed sutures.

This step restores the midline, improves core stability, and enhances cosmetic appearance.

Mesh Reinforcement

A dual-surface or composite mesh is introduced into the abdomen.

The mesh is placed intraperitoneally, covering the repaired area with at least 5 cm overlap beyond all margins.

Fixation is achieved using transfascial sutures, absorbable tackers, or glue to ensure durability.

Completion

Pneumoperitoneum is released, ports are removed, and incisions are closed.

Postoperative Care

Early mobilization is encouraged to prevent thromboembolic events.

A graduated diet is resumed within hours post-surgery.

Pain is usually mild and managed with oral analgesics.

An abdominal binder may be advised to support the repaired wall.

Patients are discharged within 24–48 hours in most cases.

Heavy lifting and strenuous activities are avoided for 6–8 weeks to protect the repair.

Advantages of Laparoscopic Approach

Minimally invasive with smaller scars and less postoperative pain.

Enhanced visualization for precise closure of defects.

Simultaneous repair of rectus diastasis and incisional hernia.

Lower wound complication rates, especially in obese patients.

Faster recovery and return to normal activities.

Improved cosmetic outcomes with restored abdominal contour.

Outcomes and Complications

When performed with proper technique, laparoscopic repair achieves excellent functional and cosmetic outcomes. Recurrence rates are low, particularly when the midline is reconstructed and mesh reinforcement is used.

Possible complications include:

Seroma or hematoma formation

Mesh-related infection (rare)

Recurrence if suturing or mesh fixation is inadequate

Chronic pain at fixation sites

These risks can be minimized by meticulous surgical technique and careful patient selection.

Conclusion

Laparoscopic repair of rectus diastasis with incisional hernia is a modern, effective solution that combines hernia repair with abdominal wall reconstruction. It restores midline anatomy, strengthens the core, and improves both function and appearance. With benefits of minimally invasive access, reduced pain, faster recovery, and durable results, this technique has become a preferred approach for appropriately selected patients.

By addressing both rectus diastasis and incisional hernia in a single procedure, surgeons provide not just hernia repair but comprehensive abdominal wall restoration, significantly enhancing patient quality of life.