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What changes after abdominal diastasis surgery?

Two years after I introduced REPA in Italy, it is time to evaluate what changes after abdominal diastasis surgery in terms of quality of life. Typically, patients who come to my practice suffer from lumbago, stress urinary incontinence, constipation, feeling of abdominal prolapseIn approximately 95% of cases they have aumbilical herniasometimes also other hernias of the linea alba, and in any case a very poor quality of life despite their young age. They have often read a lot about their illness, but are very confused: one of their concerns, almost always unexpressed, can be summed up in one question: chat changes after abdominal diastasis surgery? If I decide to take this step, which is not an easy one, and with all the difficulties, including economic ones, involved, will my quality of life improve?

This is the first question I have to answer when I am faced with one. Is it worth it? 

Today there are various tests that are able to quantify the changes in terms of quality of life after surgery. One of these is the CeQOL (Carolinas equation for Quality Of Life), launched in 2012 and originally dedicated to patients undergoing surgery for inguinal hernia. The questions this test asks, however, are well suited to any type of abdominal wall defect. To understand what changes after abdominal diastasis surgery in patients undergoing REPAwe designed a questionnaire based on CeQOL and sent it to 120 patients, all female and with a follow-up ranging from 6 months to 2 years. Here are the results.

1. EPIDEMIOLOGY

Who are the patients who undergo the REPAthe now well-known minimally invasive endoscopic surgery for the repair of diastasis of the rectus?

Typically, these are young women (the average age is 42), which have given birth on average twicehaving been subjected in the majority of cases to caesarean section. They are generally patients in excellent health, thin (the average weight is about 55 kg, the BMI average is just over 21), sporty, with an intense social and family life. The diastasis, which they generally (but not necessarily) became aware of after the second childbirth, has devastated the quality of their family and social life; they no longer recognise themselves in their body, sometimes they are ashamed of it; in more than 70% of cases they suffer from lumbagowhich they tried to cure in every way to no avail; in almost 38% of the cases of stress urinary incontinence (but also at rest), an extremely debilitating symptom for them, even in relation to their young age. I digestive disordersin which the constipation (not present before pregnancy) are present in 53% of cases. The average size of the diastasis, at the time of the examination, is 5 cm wide; 95.7% have aumbilical hernia (whose presence he was often unaware of before the visit).

You well understand how challenging, and how seriously the task of answering the question that ultimately brought them to me must be approached: what changes after abdominal diastasis surgery? Will I have the chance to take back my life? Because that is what it is all about.

2. METHODOLOGY OF THE SURVEY.

what changes after abdominal diastasis surgery, abdominal diastasis after surgeryWe sent an e-mail to 120 patients undergoing REPA and with an average follow-up of between 6 and 26 months. Of these, 83 responded. The key question we asked to assess what changes after abdominal diastasis surgery was: made equal to 5 the intensity of a symptom x present before the surgery, how has it changed (if at all) after the surgery?

The symptoms taken into account were:

  • Lumbago
  • Urinary incontinence
  • Meteorism
  • Constipation
  • Sensation of abdominal prolapse
  • Postural defects (patients' hyperlordosis is common, and they often tend to acquire a forward leaning posture)
  • Sensation of abdominal movements (like the kicking of a foetus during pregnancy)

Here are the results:

a) LOMBALGIA: the average value reported by patients was 1

b) URINARY INCONTINENCE: also in this case it was 1

c) METEORISM (abdominal bloating): 1

d) STITICITY: 1

e) SENSATION OF ADDOMINAL PROLESSNESS: 0

f) POSTURAL DEFECTS: 1

g) SENSATION OF ADDOMINAL MOVEMENTS: 0

We then asked a difficult and dangerous question, as it is a highly subjective assessment and subject to a thousand variables: FROM 1 TO 5, HOW SATISFIED ARE YOU WITH THE 'COSMETIC' RESULT OF THE SURGERY? The average response was 4.

Many other questions, derived directly from CeQOL, were also asked about theeffect of the intervention on normal acts of daily life (getting out of bed, climbing stairs, coughing, playing sports...); the data were collected in an article to be published in a prestigious scientific journal, and therefore cannot be released at the moment; however, I can say that they are extremely satisfactory, and I will share the article as soon as it is printed.

CONCLUSIONS: WHAT CHANGES AFTER ABDOMINAL DIASTASIS SURGERY IN THE 'QUALITY OF LIFE' OF OPERATED PATIENTS?

It changes a lot. Symptoms present before surgery and considered debilitating by patients are reduced extremely significantly or disappear completely after surgery. Patients regain their lives and, with it, their happiness: and all this with an intervention, the REPAwhose minimum invasiveness is certified by the fact that in only 4.3% of the cases did patients have to take painkillers for more than a week (the average drainage maintenance time).

What more can I add? I can only declare myself extremely satisfied with the work carried out by me and my team to date. But this can only be fuel for the next challenge: disseminate the technique as widely as possible, spread the results, so that more and more patients can benefit from it.

In this I also need the help of those who read: help me, share this data as much as possible, share my articlesThose suffering from diastasis of the rectus will only be able to thank you in the future.

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