Types of Surgical Diastasis Repair & The Non-Surgical Alternative
To be clear, the surgical repair of diastasis without the presence of a hernia is controversial among surgeons. There is no current national guidance in the medical community on the treatment of abdominal separation, and there are very few studies assessing the success rates of surgery for treating diastasis. What complicates the surgical question is that there are two avenues of approach for treatment: using a mesh patch and opting of a non-mesh method to treat diastasis recti. What convolutes the whole equation in my mind is that the non-mesh method, while much safer, is often ineffective in my opinion. And the mesh procedure, which appears to work in terms of closing the gap, potentially opens the patient up to massive infection, chronic pain and a series of other unwanted side effects, currently being monitored by the FDA. So the options are really a double-edged scalpel, so to speak.
First, let’s take a look at the non-mesh option, technically referred to as the plication of the linea alba. (That’s just a fancy way of saying “folding up the connective tissue like accordion and stitching it together to bring the recti muscles closer together.”) On the positive side, this can be done with laparoscopic surgery, which has its advantages in terms of reduced recovery time, less pain and a smaller chance of wound infection than in conventional open surgery. The folding and stitching of the linea alba does appear to strengthen a person’s abdominal support system. However, nobody ever said for how long. At the time of writing this, I’ve found NO case studies assessing the long-term effectiveness of plication surgery. Or even the short-term success.
While some surgeons claim that because they make the sutures in several rows, using permanent nylon, so they provide a lot of support and don’t dissolve, I’ve seen evidence to the contrary. More than once I’ve had clients who have literally busted their stitches by putting undue inter-abdominal force on their recti muscles after surgery. And I’m not talking about by doing crunches. I’m talking about by living. Doctors generally tell their patients to take it easy on their abs for a couple of weeks after surgery, and they mean don’t start doing crunches. (Not that you should ever start doing crunches!) But they don’t think about the fact that everyday actions—like having a bowel movement— put force on the recti muscles and can undo an entire operation.
With the end goal of teaching clients to make their abdominal surgery successful for the long-term, I produced a video called Ab Rehab, which teaches you how to go about living your everyday life after a surgical procedure without exerting force on the muscles that need to heal.
These are the basic principles of the Tupler Technique® that you should be doing regardless, but I also give you pre-op advice to maximize your chances of success.
I will concede that every year new medical technologies come about, and perhaps the indestructible, non-degrading suture thread will soon be unveiled. But I haven’t seen evidence of it yet, nylon or not nylon, and by the lack of research on the procedure, I’m not holding my breath.
In my professional opinion, based on the evidence I’ve seen, if someone masters The Tupler Technique® before abdominal surgery, they’ve got a great chance of maintaining the integrity of their stitches afterwards. But in the case of only having a diastasis and no hernia, why not just learn to heal your muscles using the program? On the flip side of the coin, I have reason to believe that a patient who doesn’t learn The Tupler Technique® before ab surgery, no matter what kind of surgery it is or what shape they’re in, runs a big risk of being right back at square one in a short time.
The other kind of diastasis surgery besides the plication method is a mesh patch procedure, sometimes referred to as a “plug-and-patch” technique. The mesh procedure is not commonly used for a diastasis alone, but it’s often used for hernia repair or in cases where previous diastasis surgery has failed. (I told you not to trust those sutures without learning the Tupler Technique®!)
Truth be told, I shudder when I hear the word mesh in a surgical context. The mesh is a synthetic material, as piece of which is placed inside the hernia or diastasis, with another patch on the other side for reinforcement before the incision is sewn up. Does it provide adequate abdominal support? Generally, you bet it does! But the mesh is also now known to cause chronic long-term pain or infection in a startling number of patients. (The Wall Street Journal quotes it as 30% in the article “A Secret for Patients Undergoing Hernia Surgery,” Feb. 28, 2012.)
There are many complications that can happen as a result of the mesh. For starters, infections caused by it are notoriously common, and adhesions can form, where loops of the intestines stick to the mesh patch. Other organs, nerves and blood vessels can also get tangled up in it and injured, because the mesh can act like a straightedge, causing excruciating, searing pain. Some patients turn out to be drastically allergic to the synthetic material with unsettling consequences. The mesh can also degrade and become embedded into the body’s tissue, which can make it something of a nightmare to remove, if it’s necessary. In these cases, it’s not uncommon for a patient to need three separate surgeries to detangle the mesh from the surrounding tissue without damaging the tissue.
Another factor in the rise of problems stemming from surgical mesh is the fact that surgical mesh kits are now marketed and sold inexpensively to surgeons who might not otherwise be performing this type of surgery. The surgeons who utilize these kits often do not have much formal training or the same amount of experience in the area of hernia repair as do the physicians who operate without them.
On the FDA website (fda.gov) in the surgical device section, there is a report on surgical mesh for hernia repair, which cites the complications and adverse reactions that can result from mesh use. So, while a mesh patch might work for some, it’s not a decision to take lightly. If you are considering this as an option, you should certainly consult with your surgeon about the particular kind of mesh being used and his or her experience with it. The FDA site also outlines some good questions pertaining to the use of mesh that you should discuss with your doctor.
[Needless to say, if you don’t have a hernia or severe tear, or a super-wide diastasis that is resistant to healing, I would certainly try to heal your separation naturally before you even think about mesh.]
Okay, so we’ve gone over the surgical options for diastasis and you know where I stand. Are there any other non-surgical methods for healing a diastasis? Sure, there are—you can easily find other methods on the internet. A smattering of them appear to be of value; some of them less so—and one or two even are based on The Tupler Technique® and created by my former students. Although I can’t accurately compare any particular other system, what I can say is this: The Tupler Technique® is the only non-surgical method of treatment for diastasis that has been clinically proven by independent research to be effective.
My client list of twenty-plus years doesn’t lie.
To learn more about Diastasis Recti & the Tupler Technique® read this article: DIASTASIS RECTI RESEARCH AND EVIDENCED BASED EXERCISE PROGRAM
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Watch the short video below to know what a diastasis is.