Surgery for Diastasis of the Rectus Abdominis Muscles (REPA and REPA MILA techniques)

May 15, 2025 –

Ernesto Escobar,MD

Diastasis recti is a common condition that primarily affects women during the third trimester of pregnancy or postpartum. It involves the abnormal separation of the rectus abdominis muscles, commonly known as the “six-pack” muscles. Quite often, diastasis is accompanied by abdominal wall hernias, predominantly around the navel.

 
 
 
Clinical image of rectus abdominis muscle diastasis (DRA) in a 30-year-old patient, 6 months postpartum. Source: Michalska et al., 2018, Ginekologia Polska. View article
Own image taken during a surgical procedure for repair of rectus abdominis diastasis (REPA technique).

For a long time, diastasis recti was considered merely a postpartum laxity or cosmetic issue; however, this is not the case. This disruption of the abdominal wall mechanics affects individuals in various ways: it causes an imbalance between intra-abdominal and external pressure, leading to symptoms such as lower back pain, urinary incontinence, constipation, and pelvic floor muscle dysfunction.

Surgery for diastasis recti (using the REPA or REPA MILA techniques, depending on the case) is a highly effective solution that restores the abdominal wall’s structure by bringing the rectus abdominis muscles back together and repairing any associated herniae.

This surgery is performed using minimally invasive techniques along the “bikini line” through three incisions of 1 cm or less, resulting in excellent cosmetic outcomes and avoiding larger wounds. Pain management with this technique allows the procedure to be done on an outpatient basis, meaning no hospitalization is required.

But specifically, what does the procedure involve?

In this gallery, you can see Ernesto Escobar, MD during a surgical procedure repairing abdominal diastasis using the REPA technique (endoscopic retro-muscular access).
  • 1. The space between the abdominal fat and muscles is carefully dissected, thus avoiding entry into the abdominal cavity.
  • 2. The diastasis is sutured to bring the muscles back together.
  • 3. A mesh is placed over the repair area.
  • 4. Drains are placed and remain for a few days before being removed by the surgeon.
  • 5. An abdominal binder is used to prevent fluid accumulation in the dissected space.
  • 6. When there is excess skin and fat, we collaborate with plastic surgeons to perform a lipo-abdominoplasty (this is only done in selected cases, not all).

Remember, diastasis surgery is primarily a functional restorative procedure, but the cosmetic results are remarkable.

Each case should be evaluated individually to determine which type of surgery is the most suitable. To find out if you may benefit from this surgery.

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