Hernia : the journal of hernias and abdominal wall surgery · 2026
Abdominal wall function in hernia and diastasis: systematic review of evaluation methods and clinical relevance.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Brucchi Francesco, Gilardini Rosangela, Vetere Andrea, Sassun Richard, Majnardi Antonio Robecchi, Muysoms Filip, Dionigi Gianlorenzo
Аннотация
BACKGROUND: Abdominal wall function (AWF) has emerged as a pivotal outcome in patients with diastasis recti (DR) and midline ventral/incisional hernias, yet methods and timing of assessment remain heterogenous and non-standardized. This systematic review aimed to synthesize current evidence on how AWF is evaluated in the setting of DR and ventral/incisional hernia, and to appraise the clinical value of different assessment strategies.
METHODS: This systematic review was reported according to PRISMA guidelines, with a comprehensive search in MEDLINE, Scopus, Embase, and CENTRAL up to August 31, 2025 (PROSPERO: CRD420251148381). Studies assessing AWF pre and post-surgery in patients with DR and/or ventral/incisional hernia using objective measures (e.g., dynamometry, standardized physical tests) and/or patient-reported outcome measures (PROMs) were included. Risk of bias was assessed using RoB-2 for randomized trials and MINORS for observational studies.
RESULTS: Nine studies (2 randomized trials, 7 prospective cohorts; n = 688) evaluated abdominal wall function using trunk dynamometry, standardized clinical tests, and PROMs. Preoperatively, abdominal wall function was consistently impaired. Surgical reconstruction restoring the linea alba led to marked improvements: trunk strength improved on dynamometry, clinical tests normalized, and PROMs showed meaningful gains in quality of life and disability. In postpartum diastasis recti, benefits-including continence-persisted at 3 years. No meta-analysis was conducted, and all findings represent a narrative synthesis.
CONCLUSION: In patients with diastasis recti or midline ventral/incisional hernias, most studies suggest that restoration of the linea alba is associated with measurable improvements in abdominal wall function and patient-reported outcomes. Wide adoption of standardized core outcome sets-integrating pragmatic objective tests with disease-specific PROMs-and longer multicenter follow-up are essential to inform surgical decision-making and future guidelines.
METHODS: This systematic review was reported according to PRISMA guidelines, with a comprehensive search in MEDLINE, Scopus, Embase, and CENTRAL up to August 31, 2025 (PROSPERO: CRD420251148381). Studies assessing AWF pre and post-surgery in patients with DR and/or ventral/incisional hernia using objective measures (e.g., dynamometry, standardized physical tests) and/or patient-reported outcome measures (PROMs) were included. Risk of bias was assessed using RoB-2 for randomized trials and MINORS for observational studies.
RESULTS: Nine studies (2 randomized trials, 7 prospective cohorts; n = 688) evaluated abdominal wall function using trunk dynamometry, standardized clinical tests, and PROMs. Preoperatively, abdominal wall function was consistently impaired. Surgical reconstruction restoring the linea alba led to marked improvements: trunk strength improved on dynamometry, clinical tests normalized, and PROMs showed meaningful gains in quality of life and disability. In postpartum diastasis recti, benefits-including continence-persisted at 3 years. No meta-analysis was conducted, and all findings represent a narrative synthesis.
CONCLUSION: In patients with diastasis recti or midline ventral/incisional hernias, most studies suggest that restoration of the linea alba is associated with measurable improvements in abdominal wall function and patient-reported outcomes. Wide adoption of standardized core outcome sets-integrating pragmatic objective tests with disease-specific PROMs-and longer multicenter follow-up are essential to inform surgical decision-making and future guidelines.