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. 2025 Jun 27;29(1):213.
doi: 10.1007/s10029-025-03403-x.

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

Umberto Bracale  1 , Cesare Stabilini  2 , Giuseppe Cavallaro  3 , Francesca Pecchini  4 , Gerardo Sarno  1 , Ferdinando Agresta  5 , Michele Carlucci  6 , Simona Rocchetti  6 , Alberto Sartori  7 , Alberto Di Leo  8 , Jacopo Andreuccetti  9 , Giusto Pignata  9 , Ernesto Tartaglia  10 , Carlo Sagnelli  10 , Diego Cuccurullo  10 , Angelo Iossa  3 , Nereo Vettoretto  11 , Ruggiero Lionetti  12 , Camillo Bertoglio  13 , Marco Confalonieri  14 , Mario Testini  15 , Giorgio Soliani  16 , Christian Galatioto  17 , Antonio Crucitti  18 , Micaela Piccoli  4 , Giampaolo Formisano  19 , Biancamaria Iacone  1   20 , Alberto Aiolfi  21 , Giuseppa Procida  5 , Giulia Montori  5 , Salvatore Tramontano  1   22 , Andrea Balla  23 , Sara Capoccia Giovannini  2 , Marta Cavalli  24 , Giampiero Campanelli  24 , Mauro Podda  25
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The Italian national consensus conference on the diagnosis and treatment of Rectus Abdominis diastasis in Post-gravidic Women

Umberto Bracale et al. Hernia. .

Abstract

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.

Keywords: Abdominal rectus diastasis; Consensus conference; Diagnosis; Diastasis recti; Post-gravidic; Rectus Abdominis Diastasis; Treatment.

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Conflict of interest statement

Declarations. Ethics approval: This study does not involve any patient data and does not need formal ethics approval. Consent for publication: All authors of this study provided their full consent for the publication of this work. Competing interests: The Authors of this study declare that they have no competing interests.

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