Rectus Divarication &
Abdominal Wall
Reconstruction
Rectus divarication is a widening of the abdominal midline with separation of the rectus muscles.
When significant, it can affect abdominal contour, core support, comfort and physical function.
What is rectus divarication?
The rectus muscles run vertically on either side of the midline and are joined by a central band of connective tissue called the linea alba.
When this tissue stretches or weakens, the muscles move apart and the abdomen can bulge, particularly when sitting up, straining or exercising.
- Pregnancy
- Significant weight gain or loss
- Previous abdominal surgery
- Chronic increased abdominal pressure
- Genetic or connective tissue factors
When can surgery be considered?
Surgery may be appropriate when there is:
- Persistent central abdominal bulging despite rehabilitation
- Functional symptoms or reduced core support
- Interference with exercise or daily activity
- An associated ventral or umbilical hernia
- Significant abdominal wall laxity
- A meaningful impact on quality of life
Reconstructing the midline
My usual approach is to restore the abdominal wall with midline plication and mesh reinforcement.
Midline plication
The stretched linea alba is tightened with permanent sutures, bringing the rectus muscles back toward the midline and restoring tension to the central abdominal wall.
Onlay mesh reinforcement
I generally reinforce the plication with a longitudinal strip of mesh approximately 8 cm wide, centred over the reconstructed midline and suture line.
The mesh acts as additional reinforcement to the repaired linea alba.
Functional reconstruction
The aim is to restore a stronger central abdominal wall, improve core support and reduce the tendency for the reconstructed midline to progressively stretch.
Why I usually use mesh reinforcement
In significant rectus divarication, I generally do not perform plication alone.
My concern with an unsupported suture repair is that the widened midline can progressively stretch again over time, particularly when the abdominal wall is exposed to ongoing mechanical load.
Reinforcing the repair with an onlay mesh provides additional support across the reconstructed linea alba.
I use both long-term resorbable and permanent mesh depending on the patient, tissue quality and reconstruction required.
Options include long-term resorbable mesh such as Phasix (P4HB) and permanent mesh such as ProGrip.
Phasix can provide reinforcement during healing and remodelling before gradually being absorbed, while permanent mesh provides ongoing reinforcement.
There is no single mesh that is right for every patient.
What might improve?
Recovery
- Walking is encouraged early
- Heavy lifting and strenuous abdominal exercise are avoided for approximately 6 weeks
- Exercise is then reintroduced gradually
- Temporary swelling, tightness and altered sensation are common
- A binder or compression garment may be used for several weeks
Risks & limitations
- Bleeding, infection and seroma
- Delayed wound healing
- Scarring or altered sensation
- Venous thrombosis
- Recurrence or recurrent stretching of the divarication
- Persistent symptoms despite reconstruction
- Possible need for further surgery
Book an abdominal wall assessment
Assessment looks at the abdominal wall as a whole, including the rectus muscles, linea alba, associated hernias, previous scars, skin and soft tissue, weight, fitness and your goals.
The aim is to determine whether rehabilitation, weight optimisation, abdominal wall reconstruction, abdominoplasty or a combination of approaches is most appropriate.