Diastasis recti in male patients: a literature review and proposed management

Purpose: An increasing number of male patients are referred for surgical evaluation of their rectus diastasis (RD).Studies investigating the clinical relevance of RD in male patients, including the etiology, pathophysiology, and quality of life are limited. Additionally, no national or international consensus on the management of RD in male patients exist. The aim of this review is to summarize the current literature and discuss the management strategy. Methods: This paper is a multidatabase literature-based scoping review conducted according to the SANRA guidelines investigating the epidemiology, clinical presentation, and management of the rectus diastasis in male patients, including different treatment strategies. Results: Twenty-four studies were included. Studies without sex-stratified findings were excluded. Evidence focusing specifically on male symptomatology and quality of life was limited. Reported management strategies comprised physiotherapy-based core training, minimally invasive mesh repair and open plication (with or without mesh). Across studies, surgical outcomes were generally favorable, though data were heterogeneous and long-term outcomes were sparse. Conclusion: RD is more common in male patients over 60 years old with obesity and low levels of physical activity. In most cases, the condition is asymptomatic, but may cause functional symptoms when a concomitant ventral hernia is present. If surgical repair is indicated, there are several surgical options and the choice depends on the individual symptomatology, anatomy and patient concerns. However, the role of RD plication in male patients remains uncertain, and its use should be used with caution.