Hongkong Hernia Centre

Divarification of Recti

Introduction What are the signs and symptoms? Does divarification of recti need surgery? What are the surgical options? How long does it take to recover after a mesh repair of divarification?


Introduction top

Divarification of recti arise from a generalised stretching of the linea alba in the midline fibrous tissue between the bottom of the rib cage and the pelvis which in turn causes a splitting of the rectus muscles (the ‘six pack’) laterally away from the midline. This can be associated with being over-weight or can occur after pregnancy.  The separation of the rectus muscles usually occurs above or below the umbilicus and infrequently in both areas.

What are the signs and symptoms? top

Often patients have few symptoms except for a dull ache or dragging sensation in the area of divarification.  Patients often notice a progressively enlarging bulge in the midline.

Does divarification of recti need surgery? top

No. It does not usually require an operation, but surgery is indicated where there is pain or discomfort, the diffuse bulge is gradually enlarging or is cosmetically unacceptable.

What are the surgical options? top

A tension free open mesh repair is the optimal method of repair advocated by the HKHC with the lowest incidence of recurrence.  The mesh is placed in the preperitoneal plane to avoid the mesh sticking to the intestines.  The rectus muscles are then re-approximated (plicated together) to one another with sutures.  While there is a laparoscopic method of repairing this defect which is less invasive, there have been no randomised studies published thus far to demonstrate this a better way of repairing this type of hernia.  Secondly, the placement of an intraperitoneal non-adherent mesh does not allow for re-approximation of the rectus muscles to one another.

How long does it take to recover after a mesh repair of divarification? top

Unlike most other hernia repairs, it is a more major undertaking and requires an average hospital stay of 5 days.  You may not be able to return to work for about two weeks. Your ability to drive a car is governed by being able to put your right foot on the brake pedal to perform an emergency stop without inhibition (automatic transmissions) or both feet on the clutch and brake pedals (manual transmissions).  Avoidance of heavy lifting or straining for three months is recommended to allow the tissues to reach their maximal tensile strength and therefore reduce the risk of recurrence.