Ultrasound-guided botulinum toxin type A injection before preaponeurotic endoscopic repair for large diastasis recti abdominis: literature review

Introduction: Diastasis recti is a disorder of the anterior abdominal wall, more frequent in postpartum women. Recently, a minimally invasive surgical treatment for diastasis recti, the endoscopic preaponeurotic repair (REPA), has been proposed. Muscle relaxation secondary to flaccid paralysis after injection of Botulinum Toxin type A seems to facilitate surgical reconstruction by inducing medialization of the rectus muscles and reducing the suture tension, thus being useful in the repair of large diastasis recti. Case report: We present a case of ultrasound-guided bilateral administration of botulinum toxin A to the external and internal oblique muscles performed 30 days before endoscopic preaponeurotic repair in a patient with a very large (21 cm) diastasis recti. Conclusion: The preoperative use of toxin seems to be a safe and well-tolerated procedure that allows muscular medialization without tension in the repair of large diastasis recti, also reducing postoperative pain. Although further evaluation is needed, toxin injections appear to be effective in the surgical repair of large diastasis abdominis.