The Italian national consensus conference on the diagnosis and treatment of Rectus Abdominis diastasis in Post-gravidic Women

Purpose: Rectus Abdominis diastasis (RAD) is a prevalent condition, particularly in post-gravidic women, with functional and esthetic impact. This Delphi consensus, led by general surgeons, aimed to establish evidence-based recommendations for the diagnosis and management of RAD in post-gravidic women. Methods: A Delphi process was conducted under the auspices of the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS), the national chapter of the European Hernia Society (EHS). A steering committee supervised systematic literature reviews to evaluate the quality of evidence and formulate recommendations. Iterative rounds of voting involving 105 expert panellists were conducted, with Consensus defined as ≥ 70% agreement. Non-consensual recommendations were revised and discussed in a plenary session during the Italian Society of Surgery (SIC) Congress, 2024. Results: Consensus was achieved on 12 recommendations covering RAD diagnosis, classification, and treatment. Key findings included the endorsement of radiological methods for accurate RAD assessment, the establishment of surgical thresholds (> 2.5 cm inter-recti distance for symptom improvement), and the recommendation of minimally invasive linea alba plication for surgical management. Non-operative treatments, such as targeted exercise programs, were emphasized as first-line approaches. For RAD with concomitant hernias of the linea alba with defects > 1 cm, mesh reinforcement was strongly recommended, with extraperitoneal placement preferred. The importance of tailoring approaches based on patient-specific factors and fostering shared decision-making was highlighted. Conclusion: This consensus provides a structured framework for RAD management, emphasizing accurate diagnosis, tailored treatments, and patient-centered care. Future multicenter studies are required to address remaining evidence gaps and refine these recommendations.