MSS11: A SCOPING REVIEW OF THE RECTUS DIASTASIS LITERATURE
Justin P Fox, MD, FACS, MHS, CPE1; Anna M Stachura, MD2; Danielle B Holt, MD, MSS, FACS2; Ryan D Restrepo, MD, FACS2; Kerry P Latham, MD, MHPE, CPE1; 1Uniformed Services University of the Health Sciences; 2Walter Reed National Military Medical Center
Objectives: Rectus diastasis (RD) is defined by alterations to the linea alba leading to lateral displacement of the rectus muscles. No standardized approach exists to managing this condition which has led to varied counseling, expectations, and resource utilization for patients seeking treatment. Patients struggle to find accurate information leading to reliance on poor quality data generated from internet searches, social media influencers, and personal fitness trainers. Healthcare providers have access to a variable quality of information leading to uncertainty regarding the functional impact and treatment options for RD. Despite a substantial at-risk beneficiary population and a potential military readiness concern, the Military Health System does not have specific practice guidelines for this condition. More studies are needed to guide policy development, particularly for service members. This study conducted a review of the existing RD literature to map current knowledge of clinical management and to inform future practice guideline development.
Methods: Using a scoping review design, electronic databases were searched to identify articles published between January 2002 and June 2022 using key terms related to the diagnosis and management of RD (N=301). Abstracts were excluded that did not meet inclusion criteria according to pre-established guidelines (N=148). Article bibliographies were reviewed to capture citations that may have been missed during the initial search (N=34). The resultant articles were then categorized by primary focus and summarized key findings within each category.
Results: The final sample included 182 articles with an upward trend in RD publications over time. The most common groupings by primary focus included, “surgical approaches to treatment (34.1%),” “surgical outcomes and complications (20.3%),” and “non-surgical treatment and outcomes (11.5%).” The current literature describes the biologic alterations leading to RD; devises classification systems that encompass the entire state of the abdominal wall; evaluates related symptomatology; and considers non-surgical and surgical treatment options. Numerous inconsistencies exist within the current literature which may be related to variations in the definition of RD; methods of diagnosis; lack of control groups; and methods of outcome assessment.
Conclusion: RD is a common clinical condition with a growing literature to guide diagnosis and clinical management. Future studies should adopt proposed RD classification systems, utilize validated outcome measures, and evaluate impact of treatment on symptoms and function to facilitate cross-study comparisons and direct clinical practice guidelines for specific populations such as military service members.