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Prevalence of rectus diastasis is higher in patients with inguinal hernia

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Abstract

Purpose

To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia.

Material and methods

Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination.

Results

A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively.

Conclusions

The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.

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Data and material availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

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References

  1. Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, Ross D, Montgomery A (2021) European Hernia Society guidelines on management of rectus diastasis. Br J Surg 108(10):1189–1191. https://doi.org/10.1093/bjs/znab128

    Article  PubMed  Google Scholar 

  2. Kaufmann RL, Reiner CS, Dietz UA, Clavien PA, Vonlanthen R, Käser SA (2022) Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia 26(2):609–618. https://doi.org/10.1007/s10029-021-02493-7

    Article  CAS  PubMed  Google Scholar 

  3. Cavalli M, Aiolfi A, Bruni PG, Manfredini L, Lombardo F, Bonfanti MT, Bona D, Campanelli G (2021) Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia 25(4):883–890. https://doi.org/10.1007/s10029-021-02468-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Denizoglu Kulli H, Gurses HN (2022) Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol 279:40–44. https://doi.org/10.1016/j.ejogrb.2022.10.001

    Article  PubMed  Google Scholar 

  5. Yuan S, Wang H, Zhou J (2021) Prevalence and risk factors of hernia in patients with rectus abdominis diastasis: a 10-year multicenter retrospective study. Front Surg. 8:730875. https://doi.org/10.3389/fsurg.2021.730875

    Article  PubMed  PubMed Central  Google Scholar 

  6. Henriksen NA, Mortensen JH, Sorensen LT, Bay-Jensen AC, Ågren MS, Jorgensen LN, Karsdal MA (2015) The collagen turnover profile is altered in patients with inguinal and incisional hernia. Surgery 157(2):312–321. https://doi.org/10.1016/j.surg.2014.09.006

    Article  PubMed  Google Scholar 

  7. Fachinelli A, Maciel Trindade MR (2007) Qualitative and quantitative evaluation of total and types I and III collagens in patients with ventral hernias. Langenbecks Arch Surg 392(4):459–464. https://doi.org/10.1007/s00423-006-0086-9

    Article  PubMed  Google Scholar 

  8. Blotta RM, Costa SDS, Trindade EN, Meurer L, Maciel-Trindade MR (2018) Collagen I and III in women with diastasis recti. Clinics 73:e319. https://doi.org/10.6061/clinics/2018/e319

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ozdogan M, Yildiz F, Gurer A, Orhun S, Kulacoglu H, Aydin R (2006) Changes in collagen and elastic fiber contents of the skin, rectus sheath, transversalis fascia and peritoneum in primary inguinal hernia patients. Bratisl Lek Listy 107(6–7):235–238

    CAS  PubMed  Google Scholar 

  10. Köhler G, Luketina RR, Emmanuel K (2015) Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg 39(1):121–126. https://doi.org/10.1007/s00268-014-2765-y. (Discussion 127)

    Article  PubMed  Google Scholar 

  11. Nishihara Y, Asami M, Shimada T, Kawaguchi Y, Omoto K (2021) Comorbid rectus abdominis diastasis is a risk factor for recurrence of umbilical hernia in Japanese patients. Asian J Endosc Surg 14(3):368–372. https://doi.org/10.1111/ases.12868

    Article  PubMed  Google Scholar 

  12. Kvist M, Henriksen NA, Burcharth J, Nielsen YW, Jensen TK (2022) Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case-control study. Hernia. https://doi.org/10.1007/s10029-022-02719-2

    Article  PubMed  Google Scholar 

  13. Klinge U, Zheng H, Si Z, Schumpelick V, Bhardwaj RS, Muys L, Klosterhalfen B (1999) Expression of the extracellular matrix proteins collagen I, collagen III and fibronectin and matrix metalloproteinase-1 and -13 in the skin of patients with inguinal hernia. Eur Surg Res 31(6):480–490. https://doi.org/10.1159/000008728

    Article  CAS  PubMed  Google Scholar 

  14. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res 32(1):43–48. https://doi.org/10.1159/000008740

    Article  CAS  PubMed  Google Scholar 

  15. Jansen PL, Pr MP, Klinge U, Schumpelick V (2004) The biology of hernia formation. Surgery 136(1):1–4. https://doi.org/10.1016/j.surg.2004.01.004

    Article  PubMed  Google Scholar 

  16. Ranney B (1990) Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 43(10):5–8

    CAS  PubMed  Google Scholar 

  17. Reinpold W, Köckerling F, Bittner R, Conze J, Fortelny R, Koch A, Kukleta J, Kuthe A, Lorenz R, Stechemesser B (2019) Classification of rectus diastasis-a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg 6:1. https://doi.org/10.3389/fsurg.2019.00001

    Article  PubMed  PubMed Central  Google Scholar 

  18. Klinge U, Binnebösel M, Rosch R, Mertens P (2006) Hernia recurrence as a problem of biology and collagen. J Minim Access Surg 2(3):151–154. https://doi.org/10.4103/0972-9941.27729

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dessy LA, Mazzocchi M, Fallico N, Anniboletti T, Scuderi N (2013) Association between abdominal separation and inguinal or crural hernias: our experience and surgical indications. J Plast Surg Hand Surg 47(3):209–212

    Article  PubMed  Google Scholar 

  20. Demartini E, Deon KC, de Jesus Fonseca EG, Portela BS (2016) Diastasis of the rectus abdominis muscle prevalence in postpartum. Fisioter Mov 29(2):279–286

    Article  Google Scholar 

  21. Wu L, Gu Y, Gu Y, Wang Y, Lu X, Zhu C, Lu Z, Xu H (2021) Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: prevalence, risk factors and its impact on life. J Clin Nurs 30(3–4):518–527

    Article  CAS  PubMed  Google Scholar 

  22. Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L (2014) Osteosarcopenic obesity: the role of bone, and fat on health. J Cachexia Sarcopenia Muscle 5(3):183–192

    Article  PubMed  PubMed Central  Google Scholar 

  23. Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U (2011) Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol 82(11):817–821

    PubMed  Google Scholar 

  24. Nienhuijs SW, Berkvens EHM, de Vries Reilingh TS, Mommers EHH, Bouvy ND, Wegdam J (2021) The male rectus diastasis: a different concept? Hernia 25(4):951–956. https://doi.org/10.1007/s10029-021-02467-9

    Article  CAS  PubMed  Google Scholar 

  25. Emanuelsson P, Gunnarsson U, Dahlstrand U, Strigård K, Stark B (2016) 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. Surgery 160(5):1367–1375. https://doi.org/10.1016/j.surg.2016.05.035

    Article  PubMed  Google Scholar 

  26. Mommers EHH, Ponten JEH, Al Omar AK, de Vries Reilingh TS, Bouvy ND, Nienhuijs SW (2017) The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options. Surg Endosc 31(12):4934–4949. https://doi.org/10.1007/s00464-017-5607-9

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bellido Luque J, Bellido Luque A, Valdivia J et al (2015) Totally endoscopic surgery on diastasis recti associated with midline hernias. the advantages of a minimally invasive approach. Prospective cohort study. Hernia 19:493–501

    Article  PubMed  Google Scholar 

  28. Swedenhammar E, Strigård K, Emanuelsson P, Gunnarsson U, Stark B (2021) Long-term follow-up after surgical repair of abdominal rectus diastasis: a prospective randomized study. Scand J Surg 110(3):283–289. https://doi.org/10.1177/1457496920913677

    Article  PubMed  Google Scholar 

  29. McPhail I (2009) Abdominal aortic aneurysm and diastasis recti. Angiology 59(6):736–739. https://doi.org/10.1177/0003319708319940

    Article  Google Scholar 

  30. Moesbergen T, Law A, Roake J, Lewis DR (2009) Diastasis recti and abdominal aortic aneurysm. Vascular 17(6):325–329. https://doi.org/10.2310/6670.2009.00047

    Article  PubMed  Google Scholar 

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Funding

The authors have no financial relationships and have not received grant support.

Author information

Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, 60030, Tokat, Turkey

    C. Ugurlu

  2. Department of General Surgery, Hernia Istanbul Comprehensive Hernia Center, Istanbul, Turkey

    H. Gok

  3. Department of General Surgery, University of Health Science, Konya City Hospital, Konya, Turkey

    A. Sahin

  4. Department of General Surgery, Mus State Hospital, Mus, Turkey

    B. Bayar

  5. Department of General Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey

    E. Olcucuoglu

  6. Department of General Surgery, Ankara Hernia Center, Ankara, Turkey

    H. Kulacoglu

Authors
  1. C. Ugurlu
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  2. H. Gok
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  3. A. Sahin
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  4. B. Bayar
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  5. E. Olcucuoglu
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  6. H. Kulacoglu
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Contributions

CU, HG and HK: planned the study, CU, HK, HG, AS, EO, and BB: collected the data, CU: drafted the article and, H.K. did the revision of the article.

Corresponding author

Correspondence to C. Ugurlu.

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The authors state that they do not have any conflicts of interest.

Ethical approval

The Local Ethics Committee approved this study. This study, which included human participants, was carried out in accordance with the Helsinki Declaration of 1964 and its subsequent amendments.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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All participants in this study provided informed consent.

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Ugurlu, C., Gok, H., Sahin, A. et al. Prevalence of rectus diastasis is higher in patients with inguinal hernia. Hernia 27, 943–956 (2023). https://doi.org/10.1007/s10029-023-02820-0

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  • DOI: https://doi.org/10.1007/s10029-023-02820-0

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