The main characteristic of PPAWIS is relaxation of the anterior abdominal wall with accompanying abdominal rectus diastasis, caused by the sudden enlargement of abdominal circumference during pregnancy. It is often accompanied by the presence of a small umbilical hernia or linea alba hernia and the formation of  pannus (apron of excess skin and fat) with stretch marks and general body deformation. In addition to the negative impact on the perception of one's own body image, loss of self-confidence and problems in interpersonal contacts, PPAWIS is associated with the loss of body stability, pain in the back, hips, and pelvic floor dysfunction (PFD).

The surgery includes:

  • restoring rectus muscles position and closing umbilical hernia – this is important for trunk function;
  • post-reconstruction protection of the linea alba against recurrence of dehiscence, i.e. implantation of hernial mesh;
  • not damaging the rectus sheaths; for this reason, the implant is sewn onto the rectus sheath (on-lay hernia repair)
  • at the very end, ensuring a cosmetic effect by performing abdominoplasty (tummy tuck).

During the procedure, continuity of peritoneum is maintained (without open abdomen [OA]). Any opening of the peritoneal cavity is associated with formation of adhesions, so if it can be avoided leaving the peritoneal cavity intact for the next decades of patient's life, it should not be done.

The procedure is performed about 6 months after the last planned pregnancy. The studies have shown that rehabilitation process should result in resolution of linea alba dehiscence no later than 6 months after giving birth; otherwise, there will be no such possibility later, so prolonging the rehabilitation does not make sense. The procedure is also performed after weight loss to the level expected by the patient. It does not matter what weight level is; however, when the patient plans to lose more than 7-10 kg, the procedure is postponed until then. This ensures a better cosmetic effect. 

After the procedure, significant reduction of skin and fat apron and waistline restoring thanks to linea alba reconstruction can be expected. Most of the stretch marks will also disappear from this area, and the skin will be properly tightened. The final effect also depends on patient, diet or physical activity. After the procedure, a scar remains, which will become less visible over time. The incision is conducted so that it can be covered with underwear. The effects after the treatment are natural and aesthetic.

The effect is visible immediately after the operation, but the final effect is visible after complete healing of the wound, i.e. after about two months.

At the Medicover Hospital surgeries of post-partum abdominal wall insufficiency syndrome (PPAWIS) are performed by an experienced operator, Andrzej Lehmann MD PhD

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Course of the procedure

PPAWIS surgery is usually performed under general or subarachnoid anaesthesia, with an arcuate incision in the lower abdomen (with the removal of the caesarean section scar). The subcutaneous tissue is dissected above the fascia, up to the level of the costal arches and the xiphoid process. The umbilicus (belly button) is cut out of the skin. The linea alba dehiscence is reconstructed, and then an implant is placed, i.e. hernial mesh (non-absorbable/absorbable). Then, the lower skin flap is cut off and umbilicus is implanted in a new place in the skin. After the procedure, a drain is left in the subcutaneous tissue.

The operation usually takes 2-3 hours. The patient stays in the hospital usually for 2 days.

Recommendations after PPAWIS surgery

  • No physical activity for 6 weeks.
  • Hernia belt (30 cm wide, velcro-fastened) must be worn for 6 weeks (weeks 1 & 2: non-stop; the following 4 weeks: when walking).
  • Please take into account the need to obtain help from family or friends in the post­operative period; for minimum two weeks after the procedure, patients cannot take up running a household and taking care of (small) children to the full extent. The total rehabilitation time is approx. 6 weeks.

Due to the large areas of skin flap preparation and the reconstruction of the linea alba, pain may occur after the procedure. However, strong painkillers are given to relieve this pain.

Contraindications to the surgery

Breastfeeding women and women who plan to have children in the future cannot undergo the PPAWIS surgery. All infections must be treated before the procedure. Contraindications to the surgery include active cancer, kidney and liver diseases, and coagulation disorders. The final decision about surgery is always made by the doctor.

Possible post-operative complications

  • Possible post-operative complications may be related to anaesthesia and the procedure itself.
  • The risk of recurrence of linea alba dehiscence with mesh is low: 1-10%
  • Hematoma: the risk of hematoma is 1-15%; this is usually treated conservatively; large hematomas after operations are rarely observed; they may be accompanied by extensive bruising of the skin of the abdomen and perineum, lasting even for several days.
  • Seroma is a build-up of serous fluid in the wound. The risk of seroma formation varies from 0.5% to 12.2%. Most seromas are spontaneously absorbed within 6-8 weeks, so they do not require any surgical intervention. Sometimes it may be necessary to puncture and drain the seroma.

Surgery for post-partum abdominal wall insufficiency syndrome is a one-time procedure. However, it should be highlighted that weight gain, poor diet, or getting pregnant again can make the problem recur.

Contact us to learn more about our offer and get more details
Call 500 900 900
or fill in the form – and we will call you back.

Szpital Medicover
Aleja Rzeczypospolitej 5
02-972 Warszawa