Preoperative Multi-slice Computed Tomography for Planning Abdominal Wall Plication in Abdominoplasty Patients with Rectus Diastasis: A Prospective Study

Background: Safe and effective abdominal wall plication is a crucial step in abdominoplasty for treating Diastasis of Rectus muscles (DR) repair. However, standardized preoperative tools for planning the actual plication amount are lacking, and always measured intraoperatively in a subjective way depending mainly on surgeon experience. So, it is important to search for an objective to standardize the amount of plication preoperative. Objective: This work aims to investigate the reliability of preoperative Multi-Slice Computed Tomography (MSCT) in predicting intraoperative plication measurements for DR repair during abdominoplasty.Patient and Methods: Preoperative MSCT scans measured DR in 13 female patients seeking abdominoplasty at three levels: midway between the xiphoid process and umbilicus (MW-XU), umbilical level (UL), and midway between the umbilicus and pubic symphysis (MW-US). During surgery, DR plication was performed based on a clinical assessment, and the actual plication amount was measured at the same three anatomical levels. Intraabdominal pressure (IAP) and peak airway pressure (PAP) were monitored to avoid over or under plication. Patients were categorized into two groups: Group I, in which MSCT-calculated plication was equivalent to intraoperative plication (± 0.5 cm), and Group II, in which MSCT-calculated plication was less than intraoperative plication (difference >0.5 cm).Results: Statistical analysis revealed significant differences between the MSCT-calculated and intraoperative plication measurements in Group II (9 cases) (p<0.05 at all levels), while no significant differences were observed in Group I (4 cases) (p>0.05). All IAP and PAP measurements remained within safe limits (<12 mmHg) after plication. Seroma formation was the most common complication (30.77%).Conclusion: Although MSCT can be a helpful adjunct in preoperative planning, relying solely on MSCT-calculated plication measurements may be insufficient for guiding optimal surgical strategies. Surgeon experience and intraoperative assessment remain crucial for determining the appropriate amount of plication in abdominoplasty with DR repair.