Mesh suture repair of rectus diastasis with and without a concurrent ventral hernia

The optimal technique for rectus diastasis (RD) repair, particularly when a ventral hernia is present, remains undefined. Mesh suture is a novel device designed to resist suture pull-through in high-tension closures. This study evaluates the technical feasibility and early outcomes of mesh suture use for linea alba plication during open abdominoplasty, with and without concurrent ventral hernia repair. A retrospective review of consecutive cases of abdominoplasty with mesh suture linea alba plication was performed between January 2023–2025. Patients who underwent concurrent procedures (hernia repairs, hysterectomies, and tumor excisions) were included. Patients were excluded if planar mesh was used. Forty-seven patients met inclusion criteria. The average BMI was 26.6 and mean age was 47.9 years. The mean RD width was 5.0 cm. 51% of patients had an existing preoperative ventral hernia and 61.7% of patients underwent a concurrent procedure. Most patients had a standard low transverse incision (68.1%). There was one superficial infection (2.1%), four seromas (8.5%), one hematoma (2.1%), and four soft tissue breakdowns (8.5%). There were no chronic draining sinuses, fistulae, chronic pain, or suture palpability reported. There was one early hernia recurrence (4.2%) among a patient with a preoperative hernia. Mesh suture appears to be a feasible option for RD plication in patients undergoing abdominoplasty with and without concurrent hernia repair or other abdominal procedures and was associated with low short-term complication rates in this small, single-surgeon series. These early findings, while encouraging, reflect a heterogenous and limited cohort, and follow up was insufficient to assess long-term recurrence, particularly in patients with hernias > 1 cm. As an initial feasibility study, this work supports further investigation in larger, well-controlled cohorts, ideally stratified by hernia size and with prospective, long-term follow up, to evaluate the durability, safety, and generalizability compared to standard practices.