The Italian national consensus conference on the diagnosis and treatment of Rectus Abdominis diastasis in Post-gravidic Women.

IF 2.4 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-06-27 DOI:10.1007/s10029-025-03403-x

Umberto Bracale, Cesare Stabilini, Giuseppe Cavallaro, Francesca Pecchini, Gerardo Sarno, Ferdinando Agresta, Michele Carlucci, Simona Rocchetti, Alberto Sartori, Alberto Di Leo, Jacopo Andreuccetti, Giusto Pignata, Ernesto Tartaglia, Carlo Sagnelli, Diego Cuccurullo, Angelo Iossa, Nereo Vettoretto, Ruggiero Lionetti, Camillo Bertoglio, Marco Confalonieri, Mario Testini, Giorgio Soliani, Christian Galatioto, Antonio Crucitti, Micaela Piccoli, Giampaolo Formisano, Biancamaria Iacone, Alberto Aiolfi, Giuseppa Procida, Giulia Montori, Salvatore Tramontano, Andrea Balla, Sara Capoccia Giovannini, Marta Cavalli, Giampiero Campanelli, Mauro Podda

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引用次数: 0

Abstract

Purpose: Rectus Abdominis diastasis (RAD) is a prevalent condition, particularly in post-gravidic women, with functional and esthetic impact. This Delphi consensus, led by general surgeons, aimed to establish evidence-based recommendations for the diagnosis and management of RAD in post-gravidic women.

Methods: A Delphi process was conducted under the auspices of the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS), the national chapter of the European Hernia Society (EHS). A steering committee supervised systematic literature reviews to evaluate the quality of evidence and formulate recommendations. Iterative rounds of voting involving 105 expert panellists were conducted, with Consensus defined as ≥ 70% agreement. Non-consensual recommendations were revised and discussed in a plenary session during the Italian Society of Surgery (SIC) Congress, 2024.

Results: Consensus was achieved on 12 recommendations covering RAD diagnosis, classification, and treatment. Key findings included the endorsement of radiological methods for accurate RAD assessment, the establishment of surgical thresholds (> 2.5 cm inter-recti distance for symptom improvement), and the recommendation of minimally invasive linea alba plication for surgical management. Non-operative treatments, such as targeted exercise programs, were emphasized as first-line approaches. For RAD with concomitant hernias of the linea alba with defects > 1 cm, mesh reinforcement was strongly recommended, with extraperitoneal placement preferred. The importance of tailoring approaches based on patient-specific factors and fostering shared decision-making was highlighted.

Conclusion: This consensus provides a structured framework for RAD management, emphasizing accurate diagnosis, tailored treatments, and patient-centered care. Future multicenter studies are required to address remaining evidence gaps and refine these recommendations.

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意大利关于产后妇女腹直肌转移的诊断和治疗的全国共识会议。

目的：腹直肌转移（RAD）是一种常见的疾病，特别是在产后妇女中，具有功能和审美影响。由普通外科医生领导的德尔菲共识旨在为产后妇女RAD的诊断和管理建立循证建议。方法：在意大利疝气和腹壁外科学会（ISHAWS），欧洲疝气学会（EHS）国家分会的主持下进行德尔菲过程。指导委员会监督系统的文献综述，以评估证据的质量并制定建议。105名专家小组成员进行了反复投票，共识定义为同意度≥70%。非协商一致的建议在2024年意大利外科学会（SIC）大会的全体会议上进行了修订和讨论。结果：对RAD的诊断、分类和治疗等12项建议达成共识。主要发现包括认可准确评估RAD的放射学方法，建立手术阈值（> - 2.5 cm直肌间距用于症状改善），以及推荐微创白线应用于手术治疗。非手术治疗，如有针对性的锻炼计划，被强调为一线方法。对于RAD合并白色线疝并有bbb1cm缺陷，强烈建议补片加固，首选腹膜外置入。会议强调了根据患者具体因素制定方法和促进共同决策的重要性。结论：这一共识为RAD的管理提供了一个结构化的框架，强调准确的诊断、量身定制的治疗和以患者为中心的护理。未来的多中心研究需要解决剩余的证据差距并完善这些建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.