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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 prolapse; in circa il 95% dei casi hanno un’umbilical 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: cosa cambia dopo l’intervento per diastasi addominale? 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 cosa cambia dopo l’intervento per diastasi addominale nei pazienti sottoposti a REPA, abbiamo stilato un questionario basato sul CeQOL e l’abbiamo inviato a 120 pazienti, tutti di sesso femminile e con un follow-up variabile da 6 mesi a 2 anni. Ecco i risultati.


Who are the patients who undergo the REPA, l’ormai conosciutissimo intervento chirurgico endoscopico minimamente invasivo per la riparazione della diastasi dei retti?

Typically, these are young women (l’età media è 42 anni), che 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 medio è di poco superiore a 21), sportive, con un’intensa vita sociale e familiare.  La diastasi, di cui si sono accorte generalmente (ma non necessariamente) dopo il secondo parto, ha devastato la qualità della loro vita familiare e sociale; non si riconoscono più nel loro corpo, a volte ne hanno vergogna; in più del 70% dei casi soffrono di 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 (non presente prima della gravidanza) sono presenti nel 53% dei casi. La dimensione media della diastasi, al momento della visita, è di 5 cm di larghezza; il 95,7% è portatrice di un’umbilical 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: cosa cambia dopo l’intervento per diastasi addominale? Will I have the chance to take back my life? Because that is what it is all about.


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: fatta uguale a 5 l’intensità di un symptom x presente prima dell’intervento, come è cambiata (se è cambiata) dopo l’intervento?

The symptoms taken into account were:

  • Lumbago
  • Urinary incontinence
  • Meteorism
  • Constipation
  • Sensation of abdominal prolapse
  • Difetti posturali (l’iperlordosi delle pazienti è frequentissima, e spesso esse tendono ad acquisire una postura inclinata verso avanti)
  • 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





We then asked a difficult and dangerous question, as it is a highly subjective assessment and subject to a thousand variables: DA 1 A 5, QUANTO LA SODDISFA IL RISULTATO “COSMETICO” DELL’INTERVENTO? The average response was 4.

Sono state poste anche molte altre domande, derivate direttamente dal CeQOL, sull’effetto dell’intervento nei normali atti della vita quotidiana (alzarsi dal letto, salire le scale, tossire, praticare sport…); i dati sono stati raccolti in un articolo in pubblicazione su una prestigiosa rivista scientifica, e quindi non possono essere al momento diffusi; posso però dire che sono estremamente soddisfacenti, e che sarà mia cura condividere l’articolo non appena verrà dato alle stampe.


It changes a lot. Sintomi presenti prima dell’intervento e considerati debilitanti dalle pazienti si riducono in maniera estremamente significativa o scompaiono del tutto dopo la chirurgia. 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 questo ho bisogno anche dell’aiuto di chi legge: 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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