We read with great interest the article by Dr. Staalesen et al. entitled “The Effect of Abdominoplasty and Outcome of Rectus Fascia Plication on Health-Related Quality of Life in Post–Bariatric Surgery Patients” recently published in Plastic and Reconstructive Surgery.1 First, we would like to congratulate the authors on their interesting work, even though we think that the statements reported require further and more detailed analysis. Many authors emphasize that diastasis of the rectus abdominis muscle has been linked with muscle imbalance and chronic back pain.2 The correction of rectus diastasis is a procedure performed by most surgeons during abdominoplasty, considering the limited surgical time and the low recurrence rate reported, especially over a long period.3,4 Despite the improvements made in recent years, the positive health effects and patient satisfaction after plication and skin resection have been rarely evaluated, and a further investigation was needed. We consider a key element the remark regarding the abdominoplasty effectiveness to improve health-related quality-of-life in terms of both physical and psychosocial outcomes. Moreover, the detailed statistical analysis, together with the question set used, represents a crucial instrument for estimating the high degree of satisfaction for patients in consequence of the aesthetic and functional benefits received. Anyway, as the authors emphasize, we believe this is not a sufficiently accurate method for the evaluation of preoperative grade of rectus muscle diastasis and its precise amount. We consider that the minute valuation of the preoperative rectus muscle diastasis is necessary to ascertain the advantages in the patient’s quality of life derived from the said surgical procedure, in both clinical and instrumental terms. After rectus fascia plication, it is mandatory to develop a more punctual analysis regarding postoperative course, focused on the achieved preoperative data and the patient’s psychological status connected with functional damage. Magnetic resonance imaging evaluation is considered an excellent way to ascertain preoperative diastasis grade and the durability of the procedure, through an adequate follow-up period.5 Furthermore, in view of the functional complications connected with rectus muscle diastasis and possible abdominal herniations, we advise keeping the treatment results under observation for a longer period to acquire reliable data on the patient’s increased state of health. It could be useful to connect the preoperative diastasis grade with the functional and psychological benefits resulting from the procedure, referred to as patient satisfaction. Although the functional element seems to be crucial for the present study, the rectus fascia plication also yields several aesthetic benefits to patients, enforcing surgery results and improving postoperative abdominal form. Thus, we should remark that the cosmetic improvement in connection with a better abdominal tension has a great influence on the patient’s opinion. The comparison between functional and aesthetic advantages of this procedure now represents a new fundamental purpose to reach with surgical research so that further studies are required.
The authors have no financial interest to declare in relation to the content of this communication. No intramural or extramural funding supported any aspect of this work.
Matteo Signoretti, M.D.
Pietro Francesco Delle Femmine, M.D.
Giovanni Francesco Marangi, M.D.
Paolo Persichetti, M.D., Ph.D.
Plastic and Reconstructive Surgery Unit
“Campus Bio-Medico di Roma” University
1. Staalesen T, Olsén MF, Elander A. The effect of abdominoplasty and outcome of rectus fascia plication on health-related quality of life in post-bariatric surgery patients. Plast Reconstr Surg. 2015;136:750e761e.
2. Mestak O, Kullac R, Mestak J, Nosek A, Krajcova A, Sukop A. Evaluation of the long-term stability of sheath plication using absorbable sutures in 51 patients with diastasis of the recti muscles: An ultrasonographic study. Plast Reconstr Surg. 2012;130:714e719e.
3. Nahas FX, Ferreira LM, Augusto SM, Ghelfond C. Long-term follow-up of correction of rectus diastasis. Plast Reconstr Surg. 2005;115:17361741; discussion 1742.
4. van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:4153.
5. Elkhatib H, Buddhavarapu SR, Henna H, Kassem W. Abdominal musculoaponeurotic system: Magnetic resonance imaging evaluation before and after vertical plication of rectus muscle diastasis in conjunction with lipoabdominoplasty. Plast Reconstr Surg. 2011;128:733e740e.
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