Minimally Invasive Bilayer Suturing Technique for the Repair of Concomitant Ventral Hernias and Diastasis Recti

Aim Evaluation of a technique of repair of concomitant ventral hernia and diastasis recti without mesh. Methods The technique combines suturing repair of the hernia orifice and diastasis correction by suture and includes an open step through peri-umbilical incision and an endoscopic step. The study is an observational report on 77 cases of concomitant ventral hernias and DR. Results The median diameter of the hernia orifice was 1.5 cm (0.8–3). The median inter-rectus distance was 60 mm (30–120) at rest and 38 mm (10–85) at leg raise at tape measurement and 43 mm (25–92) and 35 mm (25–85) at CT scan respectively. Postoperative complications involved 22 seromas (28.6%), 1 hematoma (1.3%) and 1 early diastasis recurrence (1.3%). At mid-term evaluation, with 19 (12–33) months follow-up, 75 (97.4%) patients were evaluated. There were no hernia recurrences and 2 (2.6%) diastasis recurrences. The patients rated the result of their operation as excellent or good in 92% and 80% of the cases at global and esthetic evaluations respectively. The result was rated bad at esthetic evaluation in 20% of the cases because of skin wrinkles, due to discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer. Conclusion The technique provides effective repair of concomitant ventral hernias up to 3 cm and diastasis recti. Nevertheless, the esthetic result can be flawed, because of the discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer.