title: Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures.
abstract: The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only.
  
  
  
  Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4.
  
  
  
  One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up.
  
  
  
  There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Emanuelsson
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.affiliation: Department of Surgery, CLINTEC, Karolinska Institutet, Solna, Sweden.
authors.forename: Ursula
authors.initials: U
authors.lastname: Dahlstrand
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. Electronic address: karin.strigard@umu.se.
authors.forename: Karin
authors.initials: K
authors.lastname: Strigård
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.
authors.forename: Birgit
authors.initials: B
authors.lastname: Stark
mesh_terms: D000328:Adult; D000070630:Diastasis, Muscle / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018579:Patient Selection; D011126:Polypropylenes; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013526:Surgical Mesh / Q000706:statistics & numerical data*; D013536:Suture Techniques; D013537:Sutures; D013548:Sweden; D014057:Tomography, X-Ray Computed / Q000379:methods; D014945:Wound Healing / Q000502:physiology
chemical_list: D011126:Polypropylenes