SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOLA) MESH REPAIR FOR UMBILICAL HERNIA AND DIASTASIS RECTI: TECHNICAL DESCRIPTION

Abstract

Abstract Diastasis recti (DR) refers to the stretching and thinning of the Linea alba and the separation of muscular borders by more than 2.2 cm1, clinically manifesting as a central bulging of the Linea alba1. It leads to an increased risk in hernia recurrence after hernia repair, often linked to underlying wall weakness2,3. Various methods exist for ventral hernia repair, with the laparoscopic or open sublay approach that are technically demanding, causing significant abdominal scars. The intraperitoneal mesh technique employs a costly mesh and poses ergonomic challenges for DR plication2. Simultaneous treatment of DR and hernia repair with or without a mesh is typically performed during abdominoplasty, this technique yields unsatisfactory aesthetic outcomes for individuals lacking excess abdominal skin1. The SCOLA technique combines sub-cutaneous laparoscopic abdominal hernia repair with concurrent DR plication and onlay mesh fixation. SCOLA addresses the limitations associated with other hernia repair techniques, being minimally invasive, ergonomically favourable, utilizing an onlay mesh to reduce recurrence rates, with low risk of bowel injury or obstruction. Moreover, SCOLA delivers excellent aesthetic outcomes for patients not in need of excess skin resection1,2. However, it has its post-operative complications like seroma formation, hematoma, surgical site infections, and recurrence1,3. SCOLA technique proves a safe and effective option when applied to non-obese individuals without excess skin, averse to transverse abdominal scars, and with small umbilical or midline hernias, particularly when associated with DR. We will present the surgical technique that we performed in one of our patients.