Abdominal wall function in hernia and diastasis: systematic review of evaluation methods and clinical relevance

Background Abdominal wall function (AWF) has emerged as a pivotal outcome in patients with diastasis recti (DR) and midline ventral/incisional hernias, yet methods and timing of assessment remain heterogenous and non-standardized. This systematic review aimed to synthesize current evidence on how AWF is evaluated in the setting of DR and ventral/incisional hernia, and to appraise the clinical value of different assessment strategies. Methods This systematic review was reported according to PRISMA guidelines, with a comprehensive search in MEDLINE, Scopus, Embase, and CENTRAL up to August 31, 2025 (PROSPERO: CRD420251148381). Studies assessing AWF pre and post-surgery in patients with DR and/or ventral/incisional hernia using objective measures (e.g., dynamometry, standardized physical tests) and/or patient-reported outcome measures (PROMs) were included. Risk of bias was assessed using RoB-2 for randomized trials and MINORS for observational studies. Results Nine studies (2 randomized trials, 7 prospective cohorts; n = 688) evaluated abdominal wall function using trunk dynamometry, standardized clinical tests, and PROMs. Preoperatively, abdominal wall function was consistently impaired. Surgical reconstruction restoring the linea alba led to marked improvements: trunk strength improved on dynamometry, clinical tests normalized, and PROMs showed meaningful gains in quality of life and disability. In postpartum diastasis recti, benefits—including continence—persisted at 3 years. No meta-analysis was conducted, and all findings represent a narrative synthesis. Conclusion In patients with diastasis recti or midline ventral/incisional hernias, most studies suggest that restoration of the linea alba is associated with measurable improvements in abdominal wall function and patient-reported outcomes. Wide adoption of standardized core outcome sets—integrating pragmatic objective tests with disease-specific PROMs—and longer multicenter follow-up are essential to inform surgical decision-making and future guidelines.