Effect of endoscopic pre-aponeurotic repair of diastasis recti on gastroesophageal reflux symptoms: An observational retrospective study.

Abstract

Background: Diastasis recti (DR) is a common condition, particularly in post-partum women, which may impair core function and alter intra-abdominal pressure (IAP). Gastro-esophageal reflux disease (GERD) is frequently associated with IAP imbalance, to which DR may be a contributing factor. This study aims to evaluate whether surgical correction of DR using pre-aponeurotic endoscopic repair (REPA) improves symptoms of GERD.

Methods: Symptom changes were assessed in 115 REPA patients using a validated questionnaire (modified Italian GERD Health-Related Quality of Life, MI-GERD-HRQL) administered pre-operatively and post-operatively. All respondents had a body mass index (BMI) ≤ 25 and no other relevant gastrointestinal or systemic comorbidities.

Results: This study showed a significant reduction in both prevalence and severity of GERD symptoms after surgery. The presence of reflux symptoms decreased from 75% pre-operatively to 50% post-operatively, p < 0.001. In particular, a significant reduction in prevalence was observed for heartburn after meals (28% vs. 57%), sensation of reflux (19% vs. 57%), reflux after meals (25% vs. 57%), heartburn (30% vs. 54%) and reflux when lying down (24% vs. 53%). Mean MI-GERD-HRQL score went from 16 (± 17) pre-operatively to 5 (± 10) post-operatively, p < 0.001. Mean scores for all symptoms examined showed a significant reduction in the post-operative period. Male sex, age ≥ 50 years and patients' geographical location (Italian sub-group) did not influence post-operative MI-GERD-HRQL score.

Conclusions: Our findings suggest a possible mechanistic link between abdominal wall integrity and GERD. Epidemiological and prospective comparative studies are necessary to validate our results and provide a more precise understanding of the physiological impact of DR repair on GERD.