Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parker MA, Millar LA, Dugan SA (2009) Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related? J Women’s Health Phys Ther 33(2):15–22
Emanuelsson P, Gunnarsson U, Dahlstrand U, Strigård K, Stark B (2016) Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 160(5):1367–1375
Mommers EHH, Ponten JEH, Al Omar AK, de Vries Reilingh TS, Bouvy ND, Nienhuijs SW (2017) The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options. Surg Endosc 31(12):4934–4949
Kohler G, Luketina RS, Emmanuel K (2015) Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg 39:121–126
Core GB, Mizgala CL, Bowen JC, Vasconez LO (1995) Endoscopic abdominoplasty with repair of diastasis recti and abdominal wall hernia. Clin Plast Surg 22(4):707–722
Corrêa MA (1995) Videoendoscopic subcutaneous techniques for aesthetic and reconstructive plastic surgery. Plast Reconstr Surg 96(2):446–453
Köckerling F, Botsinis MD, Rohde C, Reinpold W, Schug-Pass C (2017) Endoscopic-assisted linea alba reconstruction: New technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis. Eur Surg 49(2):71–75
Muas DMJ, Verasay GF, Garcia WM (2017) Reparación endoscópica prefascial de la diástasis de los rectos: descripción de una nueva técnica. Rev Hispanoam Hernia 5(2):47–51
Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg 402(1):173–180. https://doi.org/10.1007/s00423-016-1522-0
Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, Sibia US, Park A, Novitsky Y (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2
Muysoms F, Van Cleven S, Pletinckx P, Ballecer C, Ramaswamy A (2018) Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia 22(6):1101–1111. https://doi.org/10.1007/s10029-018-1825-x
Claus CMP, Malcher F, Cavazzola LT, Furtado M, Morrell A, Azevedo M, Meirelles LG, Santos H, Garcia R (2018) Subcutaneous only laparoscopic approach (SCOLA) for ventral vernal hernia repair: technical description and initial results. Arq Bras Cir Dig 31(4):e1399. https://doi.org/10.1590/0102-672020180001e1399 (PMID: 30539974; PMCID: PMC6284377)
Juárez Muas DM (2019) Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc 33(6):1777–1782. https://doi.org/10.1007/s00464-018-6450-3
Bellido Luque J, Bellido Luque A, Valdivia J, Suarez Grau JM, Gómez Menchero J, García Moreno J, Guadalajara Jurado J (2015) Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study. Hernia 19(3):493–501
ElHawary H, Abdelhamid K, Meng F, Janis JE (2020) A comprehensive, evidence-based literature review of the surgical treatment of rectus diastasis. Plast Reconstr Surg 146(5):1151–1164. https://doi.org/10.1097/PRS.0000000000007252 (PMID: 33136963)
Hickey F, Finch JG, Khanna A (2011) A systematic review on the outcomes of correction of diastasis of the recti. Hernia 15(6):607–614. https://doi.org/10.1007/s10029-011-0839-4
Dong CT, Sreeramoju P, Pechman DM, Weithorn D, Camacho D, Malcher F (2020) SubCutaneous OnLay endoscopic Approach (SCOLA) mesh repair for small midline ventral hernias with diastasis recti: an initial US experience. Surg Endosc. https://doi.org/10.1007/s00464-020-08134-x (PMID: 33206243)
Claus C, Malcher F, Cavazzola LT (2020) Comment to: TESLAR for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation. Should subcutaneous endoscopic mesh placement be abandoned? Hernia 24(6):1411–1412
Seretis K, Goulis D, Demiri EC, Lykoudis EG (2017) Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis. Aesthet Surg J 37(3):316–323. https://doi.org/10.1093/asj/sjw192 (PMID: 28158391)
Malcher F, Lima DL, Lima RNCL, Cavazzola LT, Claus C, Dong CT, Sreeramoju P (2021) Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair. Why so many different names for the same procedure? A qualitative systematic review. Surg Endosc. https://doi.org/10.1007/s00464-021-08560-5 (PMID: 34031740)
Funding
No funding was received or utilized for this work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Drs Claus discloses consulting fees from Medtronic, outside the submitted work. Dr Cavazzola discloses consulting fees from Strattner and Medtronic, outside the submitted work. Dr Malcher discloses consulting fees from BD & Medtronic, outside the submitted work.
Ethics approval
Not applicable.
Informed consent
Not Applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Claus, C., Cavazzola, L. & Malcher, F. SubCutaneous OnLay endoscopic Approach (SCOLA) for midline ventral hernias associated with diastasis recti. Hernia 25, 957–962 (2021). https://doi.org/10.1007/s10029-021-02465-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-021-02465-x