SubCutaneous OnLay endoscopic Approach (SCOLA) mesh repair for small midline ventral hernias with diastasis recti: An initial US experience

Dong, Caroline; Sreeramoju, Prashanth; Pechman, David; Weithorn, David; Camacho, Diego; Malcher, Flavio

doi:10.1007/s00464-020-08134-x

Cited by 17 publications

(18 citation statements)

References 18 publications

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“…Table 6 shows our results and those of the main series published on endoscopic diastasis recti repair [6,[21][22][23][24][25]. In our study, postoperative complication rates were lower than those in the majority of other series, whereas the sample size and follow-up duration were among the largest available.…”

Section: Discussionmentioning

confidence: 47%

Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon’s experience

Cuccomarino¹,

Bonomo

Aprà³

et al. 2021

Surg Endosc

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Background Diastasis recti is a pathology that affects not only the abdominal wall but also the stability of lumbopelvic muscles, consequently altering urinary and digestive functionality. Preaponeurotic endoscopic repair (REPA) is an endoscopic alternative to tummy tuck for the treatment of diastasis. In this study, the outcomes of REPA application by a single surgeon are presented. Methods A total of 172 patients underwent REPA for the treatment of diastasis recti between August 2017 and December 2019. One hundred twenty-four patients were followed for at least one year. Sixty-three patients responded to a survey on satisfaction and quality of life 12 months after surgery. Results Three (2.4%) recurrences occurred, of which two occurred in the same patient. The main postoperative complications observed were 12 (9.7%) seromas, 3 (2.4%) haematomas, a single wound infection, 3 (2.4%) cases of skin fold formation, and a case of trophic skin lesion that required negative pressure therapy. Quality of life after surgery, as reported by 63 patients who responded to the survey, was satisfactory. Conclusions REPA is a safe and effective technique for diastasis recti treatment, representing a valid alternative to abdominoplasty. Since there is no need to access the peritoneal cavity and the mesh is onlay, there are no risks of bowel damage or adhesions between the intestine and prosthesis.

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Section: Discussionmentioning

confidence: 47%

Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon’s experience

Cuccomarino¹,

Bonomo

Aprà³

et al. 2021

Surg Endosc

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“…Recurrence rate was 4%, with a possible correlation between recurrence and self-gripping mesh without additional fixation, reported in the American study. Recurrence rate seems to be low all across different publications, ranging from 0 to 12.5%, but longer follow-up is lacking [17]. In the Brazilian series, the patient satisfaction index was 93.7% [12].…”

Section: Discussionmentioning

confidence: 89%

“…The technique described was used in some published articles, two of them reporting our personal experience (Brazilian and American series of patients), involving a total of 64 patients [12,17]. There are currently more than 150 operated patients by our groups, with few technical modifications over Fig.…”

Section: Discussionmentioning

confidence: 99%

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SubCutaneous OnLay endoscopic Approach (SCOLA) for midline ventral hernias associated with diastasis recti

Claus

Cavazzola

Malcher

2021

Hernia

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Introduction Minimally invasive surgery for diastasis recti has gained attention in the recent past, with several reports with different names and particularities being suggested by the authors. SCOLA (Subcutaneous OnLay endoscopic Approach) is an example of this technique, described here in standardized technique. Description of the technique Basic steps to perform the procedure are detailed, beginning with patient and surgical team positioning, including trocar placement and tips and tricks of the subcutaneous dissection, steps needed to achieve full dissection of the preaponeurotic space, diastasis recti plication, mesh positioning and fixation and drain positioning with fixation of the umbilical stalk. Discussion Regardless of different names and small technical variations, endoscopic pre-aponeurotic mesh positioning can be performed with well-established steps on a reproducible fashion, aiming to achieve better results. Careful attention should be paid to appropriate patient selection and drain placement to reduce seroma rate, the most common complication.

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“…Myofascial release of the rectus with concomitant plication of the defect and placement of an absorbable mesh is carried out. Claus et al and Dong et al have described their SCOLA experience in Brazil and the US, respectively [ 11 ]. We present our experience of this procedure for ventral hernia with DR at a tertiary care setup in India.…”

Section: Discussionmentioning

confidence: 99%

A Novel Modification of Subcutaneous Onlay Endoscopic Repair of Midline Ventral Hernias With Diastasis Recti: An Indian Experience

Shinde¹,

Chakravarthy²,

Karvande³

et al. 2022

Cureus

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Introduction A ventral hernia is a common problem in the population. Many patients with umbilical/epigastric hernia often present with diastasis recti (DR) too. Diastasis recti is the thinning of the linea alba with an abnormal increase in the distance between the recti without a concomitant fascial defect. The presence of diastasis recti complicates the repair of the existing umbilical/epigastric hernia. Repair of only the umbilical/epigastric hernia in the presence of DR results in incomplete repair and predisposes to recurrence. There are various options available for the repair of umbilical hernia with diastasis recti. Open hernia repairs often have unsatisfactory cosmetic outcomes and, furthermore, involve complications frequently associated with large incisions such as surgical site occurrences (SSO), pain, dermal flap necrosis, and delayed postoperative recovery, to name a few. The era of minimal access surgery leaves us with a vast array of creative solutions to the same. Laparoscopic onlay repair has been given various names in literature, e.g., minimally invasive linea alba reconstruction (MILAR), pre-aponeurotic endoscopic repair (REPA), endoscopic linea alba reconstruction (ELAR), subcutaneous onlay laparoscopic approach (SCOLA), and totally endoscopic assisted linea alba reconstruction (TESLAR), with similar principles for all the procedures. The average rate of seroma formation in these procedures varies from 5% to 40%. SCOLA has been used in our study, with an added modification of the operating port and limiting the extent of lateral dissection with the aid of spinal needles, resulting in restrained dissection and creation of smaller lipocutaneous flaps, leading to reduced incidence of seroma formation. Methods Patients with symptomatic primary ventral hernia with concomitant diastasis recti were enrolled in the participating center from the period of May 2020 to December 2021. Thirty patients were enrolled for this prospective study. The patients underwent subcutaneous laparoscopic onlay repair of midline ventral hernia with diastasis recti, with plication of the defect and onlay placement of a polypropylene mesh. Results Six point sixty-six percent (6.66%) of the patients developed seroma and SSO. The incidence is congruent with the results available in current literature. None of the patients had necrosis of umbilical skin. There were no recurrences at the three months follow-up. Conclusion Our modification of SCOLA is an ergonomically favorable procedure and has comparable outcomes to other approaches, with minimal complications.

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SubCutaneous OnLay endoscopic Approach (SCOLA) mesh repair for small midline ventral hernias with diastasis recti: An initial US experience

Cited by 17 publications

References 18 publications

Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon’s experience

Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon’s experience

SubCutaneous OnLay endoscopic Approach (SCOLA) for midline ventral hernias associated with diastasis recti

A Novel Modification of Subcutaneous Onlay Endoscopic Repair of Midline Ventral Hernias With Diastasis Recti: An Indian Experience

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