MANAGEMENT AND MAINTENANCE OF RESULTS IN CASES OF ANTERIOR ABDOMINAL WALL LAXITY DURING ABDOMINOPLASTY.

Background: Rectus muscle plication, one of the primary procedures performed during abdominoplasty, aims to control rectus muscle diastasis by advancing the muscle to the midline, thereby restoring the normal anatomy of the abdominal wall. Constant forces like contraction of the abdominal muscles, tissue elasticity, and elevated intra-abdominal pressure have a significant impact on the durability of rectus plication. Therefore, we have to investigate the various rectus plication techniques in terms of their long-term effects and resilience. Aim of the work: to determine the optimal plane and technique for polypropylene mesh repair after abdominoplasty, and the longevity of various rectus sheath plication techniques. Our primary goal is to design an algorithm for managing rectus diastasis. Patients and Methods: Ninety female patients seeking abdominoplasty or post-bariatric body contouring surgery participated in this prospective study, which was carried out at the Mansoura Burn and Plastic Surgery Center between August 2020 and July 2022. Patients were randomized to one of the three treatment groups using simple randomization. Group 1: (30 patients) Vertical rectus plication in double continuous layers was done. Full abdominoplasty and liposuction were done. Group 2: (30 patients) TULUA procedure Group 3: (30patients) Polypropylene mesh was used (especially if hernia was encountered) either in retro-rectus position over the posterior rectus sheath (10 patients), over the muscle and involved with plication (10 patients) or over the vertical rectus plication (10 patients). Full abdominoplasty and liposuction were done.Results: In group 1, the results obtained by US were similar to the results obtained by multiple studies. In group 2, the diastasis was more at the level of xiphoid than in other groups. In group 3, the 6 months results are the best result regarding durability.Conclusion: Standard vertical plication is insufficient for optimal outcomes. The authors consider mesh application, if feasible, as it enhances the correction of abdominal wall laxity and yields durable outcomes. The use of mesh at the sub-rectus muscle level yields optimal results with minimal problems. An algorithm is created to help in decision-making in abdominoplasty.