New Concepts in Diastasi Recti Surgery Minimally Invasive Surgical Techniques and Patient Management

This book sheds new light on the anatomy, pathophysiology, clinical implications, and surgical interventions for diastasis of the rectus abdominis muscles. Diastasis recti is a prevalent condition, affecting approximately one-third of women post-delivery. Often dismissed as merely an aesthetic issue, recent research over the past 15 years has revealed its profound functional implications on core stability, lumbar support, pelvic floor function, and the overall integrity of the antero-lateral abdominal wall.

The chapters cover topics such as the latest advancements in minimally invasive surgery—including laparoscopic, endoscopic, and robotic techniques—highlighting how these methods effectively address the functional issues associated with diastasis recti. Readers will discover insights into how this condition can be a significant risk factor for linea alba hernias and the recurrence of umbilical and median incisional hernias. Contributions from renowned experts provide a comprehensive analysis of current research and personal experiences, making this book an essential resource for understanding and treating diastasis recti.

INTRODUCTION 1. Why an abdominal wall surgeon should operate a diastasis recti?.- PART I 2. Surgical anatomy of the anterolateral wall of the abdomen and classification of the diastasis recti.- 3. Epidemiology and causes of diastasis recti.- 4. Pathophysiology and clinical aspects of diastasis recti.- 5. Diagnosis and surgical indications.- 6. Gender-specific differences in etiology, symptomatology, indication and choice of technique of Rectus diastasis associated with midline hernias.- 7. Preparing the patient for surgery.- PART II 8. Open diastasis recti surgery: abdominoplasty.- 9. Endoscopic preaponeurotic repair (REPA).- 10. The totally extraperitoneal repair (TEP).- 11. Robotic repair.- 12. Repair of large diastasis recti.- 13. Anesthetic techniques and postoperative pain control.- 14. Minimally invasive lipoabdominoplasty (MILA).- 15. The Role of Physiotherapy.- 16. Long-term outcomes and prevention of postoperative complications in diastasis recti surgery.

Dr. Cuccomarino graduated with honors in Medicine and Surgery and specializedn General Surgery with top marks at the University of Bologna Alma Mater Studiorum. He therefore spent a year at the Federal Hospital of Salzburg, Austria to learn the techniques of laparoscopic and minimally invasive surgery. He therefore moved to Spain

where he worked in the most important coloproctology center in the Basque Country (the Centro Guipuzcoano de Coloproctologia), where he perfected the techniques of advanced laparoscopic surgery, endovascular phlebology and bariatric and metabolic surgery; he maintaned his contacts with the Ispanoamerican surgical world even after returning to Italy, and is now an international instructor of open and laparoscopic surgery of the abdominal wall, a title awarded in 2013 by the University of Panama for his intense teaching and operating activity in Latin America.

He has performed over 5000 major operations as first operator. His main fields of interest areminimally invasive surgery for hernias, incisional hernias and diastasis recti, laparoscopic surgery of the colon, rectum and anal region, laparoscopic surgery for morbid obesity, phlebology with LASER endovascular methods and laparoscopic surgery of the stomach and gastro-esophageal junction.

In 2020 he conceived, performed and published for the first time in the world the first minimally invasive anterior separation technique of the components for the repair of complex incisional hernia, and in 2021 he realized for the first time in the world the repair of a parastomal hernia with the IVO (Instituto Valenciano de Oncologia), a technique performed by minimally invasive endoscopic / laparoscopic approach.

Dr. Cuccomarino is a member of many scientific societies, including the SIC (Italian Society of Surgery), the ACOI (Association of Italian Hospital Surgeons), the EHS (European Hernia Society), the ESCP (European Society of Coloproctology),the AEC ( Asociación Española de Cirujanos), the SoHAH (Sociedad Hispano-Americana de Hernia), the ESSR (European Society for Surgical Research). Since 2024, he is professor of Surgery of the diastasis recti in the Master of Surgery of the abdominal wall of the Francisco de Vitoria University of Madrid (Spain) and professor in the specialization school in General Surgery of the university of Catania (Italy)

Dr. Ezequiel M.Palmisano is a specialist in General Surgery; Member of the Argentine Association of Surgery, of the Argentine Hernia Association and of the Hispanoamerican Hernia Society; Foreign Corresponding Member of the Paraguayan Society of Surgery; Honorary Member of the Society of Surgeons of Tucumán; Honorary Member of the Tachirense Abdominal Wall Society; Honorary Member of the Dominican College of Surgeons; Honorary Member of the Bolivian Society of Surgery; Director of the University Course of Update in Abdominal Wall Surgery of the Italian University Institute and IAMEL Clinic of Rosario (Argentina); Head of the Hernias and Abdominal Diastasis unit of the

Metropolitan Institute of Rosario (Argentina. Author of the MILA (Minimally Invasive LipoAbdominoplasty) technique.

 Dr. Derlin M. Juares Muas is a also a Specialist in General Surgery; Member of the Argentine Association of Surgery; Member of the Hispanoamerican Hernia Society; Member of the Argentine Hernia Association;Member of the Society of Surgeons of Salta; Head of practical work of the Chair of Pathology and Surgical Clinic I and II; Staff of the Abdominal Wall Sector of the General Surgery Service of the Salt Maternal and Child Hospital. Author of the SCOLA technique.