New modified undermined suture technique for rectus muscle re-approximation at cesarean delivery-Case report

INTRODUCTION: Diastasis recti abdominis (DRA) is characterized by the separation of the two rectus abdominis muscle along the linea alba. A newly modified undermined suture rectus muscle technique at cesarean delivery is created with improved post-operative outcome.

PRESENTATION OF CASE: A 30-year-old woman, who had a previous cesarean delivery, opted for another cesarean section (CS) during this pregnancy. She claimed that her tummy was lax after her first experience of CS even with regular exercise. A standard CS procedure was carried out along with the new modified undermined suture technique for rectus muscle re-approximation. Post-operatively, the pain score was 2/10 without any evidence of hematoma, seromas or infection and the patient ambulates well. The patient did not complain of any pain or complications upon follow up after 2 weeks and 2 months post-operation. She claims that her abdomen is firmer, flatter and more stable compared to her previous operation experience.

DISCUSSION: This newly modified method prevents any defect or weakness on the anterior abdominal wall even if the rectus muscles fail to oppose itself during the healing process. It also mimics the function of the linea alba and avoid interrupting the contraction or injuring the muscle in order to avoid pain. Adhesion of the anterior uterine wall and the rectus sheath can be prevented by closure of the rectus muscle and burying the suture material within the muscle.

CONCLUSION: The newly modified undermined suture rectus muscle technique at cesarean delivery has the potential to improved patient's post-operative satisfaction.