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. 2025 Sep 2.
doi: 10.1007/s00266-025-05198-9. Online ahead of print.

Optimizing Rectus Sheath Plication in Lipoabdominoplasty: Correlation Between Corrected Distance, Intra-abdominal Pressure and Postoperative Pain

Renpeng Zhou #  1 , Xiyuan Mao #  1 , Yanping Hou  2 , Yimin Liang  3 , Danru Wang  4
Affiliations

Optimizing Rectus Sheath Plication in Lipoabdominoplasty: Correlation Between Corrected Distance, Intra-abdominal Pressure and Postoperative Pain

Renpeng Zhou et al. Aesthetic Plast Surg. .

Abstract

Background: Postpartum women often experience abdominal skin laxity and diastasis rectus abdominis. Lipoabdominoplasty, including anterior rectus sheath plication, is commonly performed to address these issues. However, excessive plication may increase intra-abdominal pressure (IAP) and postoperative pain, potentially causing complications. The relationship between plication width, IAP, and postoperative pain remains underexplored.

Objectives: This study aimed to evaluate how plication width impacts IAP and postoperative pain in patients undergoing lipoabdominoplasty.

Methods: Thirty female patients underwent lipoabdominoplasty with plication of anterior rectus sheath in two-layer suture. IAP was continuously monitored using a urodynamic analysis system (Laborie) throughout the procedure. For analysis, IAP was specifically recorded before and after the plication of the anterior rectus sheath. Postoperative pain was assessed on postoperative day 1 (POD1) using the Numeric Rating Scale for Pain. Plication width, original rectus diastasis width, and corrected distance were recorded and analyzed.

Results: Mean IAP increased significantly from 5.7 mmHg pre-plication to 9.3 mmHg post-plication (p < 0.05). Infraumbilical corrected distance (D3, 2.1±0.7 cm) showed the strongest correlation with increased IAP (R = 0.61) and postoperative pain (R = 0.5). No significant correlation was found between BMI, rectus diastasis, and pre-plication IAP. No patients exceeded IAP >12 mmHg. Minor complications occurred in 10% (3/30), including two seromas and one wound dehiscence.

Conclusions: Anterior rectus sheath plication during lipoabdominoplasty significantly increased IAP, with the infraumbilical corrected distance (D3) demonstrating the strongest influence. In our study cohort, maintaining D3≤3.6 cm (mean: 2.1 cm) consistently kept IAP below the 12 mmHg safety threshold while achieving optimal esthetic outcomes. Continuous intraoperative IAP monitoring provided an objective method for individualized plication tension adjustment. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Anterior rectus sheath; Intra-abdominal pressure; Lipoabdominoplasty; Plication; Postoperative pain.

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Conflict of interest statement

Declarations. Conflict of interest: The authors state no conflict of interest. We declare that we do not have any commercial or associative interest. Ethical Approval: All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: All participants provided written consent for the use of their images.

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