Subcutaneous onlay laparoscopic approach (SCOLA) for ventral hernia with concomitant diastasis recti: a single-center experience

BACKGROUND: Despite advances in hernia repair techniques, high recurrence rates remain a major challenge; studies report rates as high as 31.2% when DR is not addressed. Diastasis recti (DR) raises the risk of hernia recurrence after midline ventral hernia repair. About 45% of patients with umbilical or epigastric hernias also present with DR. The subcutaneous onlay laparoscopic approach (SCOLA) is a minimally invasive surgical technique that provides simultaneous treatment of hernia and DR by plicating the separated muscles and reinforcing them with an onlay mesh. OBJECTIVES: To evaluate the SCOLA technique as a safe, feasible, and effective approach for ventral hernia repair with concomitant diastasis recti. Specifically, we hypothesize that SCOLA is associated with acceptable 30-day morbidity, high patient satisfaction, and low early recurrence rates in this patient population. METHODS: . The primary outcome was 30-day morbidity, classified by the Clavien-Dindo classification. Secondary outcomes were patient satisfaction and recurrence during follow-up. RESULTS: Mean operative time was 139.6 ± 36.7 min with minimal blood loss. Most patients had umbilical hernias (11/12, 91.7%) and W3 diastasis recti (12/12, 100%). Postoperative seroma occurred in 3/12 patients (25%, 95% CI 5-57%). All were Clavien-Dindo Grade I and managed conservatively. There were no infections, skin necrosis, or mortality. Mean patient satisfaction was 9.25 ± 1.48/10. One recurrence (1/12, 8.3%, 95% CI 0.2-38.5%) occurred at 5 months post-operatively, within the study follow-up period. CONCLUSIONS: SCOLA appears safe and feasible for simultaneous ventral hernia and DR repair in selected patients, with acceptable early morbidity, high satisfaction, and low early recurrence. The small sample size, single-center methodology, and short follow-up period pose notable constraints on the strength and validity of the conclusions that can be drawn.