Gender-Specific Differences in Etiology, Symptomatology, Indication, and Choice of Technique for Treating Rectus Diastasis Associated with Midline Hernias

Background: The majority of scientific reports pertaining to rectus diastasis (RD) cover the post-gestational form. Publications focusing on male RD are rare and non-specific. The RD of both genders is different in etiology, symptomatology, indication to therapy, and appropriate technique of repair. Current discussion: The midline abdominal wall hernias associated with RD have significantly higher recurrence rate if only the hernia is repaired. The gender-specific details of RD are evaluated and separately analyzed. It begins with the anatomy, collagen composition and its turnover, etiology, lifestyle, different phases of life, and impact on quality of life and culminates in different indications to active therapy. Despite the numerous techniques described, there is no consensus on the most effective one. Conclusion: The obvious differences in masculine and feminine RD mandate individual result analysis of both sexes to create a solid basis for therapeutic decision making. Outlook: There is an urgent need to standardize the data necessary to measure the quality of outcomes. RD-specific questionnaire of patient-reported outcome measures could help to validate the outcomes in terms of patient’s quality of life improvements.