Background:Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. Aim:To describe a “new” technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. Method:SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. Results:The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. Conclusion:The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.

Purpose: To develop a reproducible training program model covering the steps of the extended totally extraperitoneal approach (e-tep) technique for correction of ventral or incisional hernia repair. Methods: Training sessions with surgeons in the laboratory using both porcine specimens and a new ethylene vinyl acetate (EVA) model simulating the operative steps of the e-tep technique. Students were interviewed and asked to answer a questionnaire pre and post the sessions to assess their performance and evaluated the course and model. Results: A total of 25 trained abdominal wall surgeons was evaluated at the end of the course. It was obtained a 100% satisfaction score of the training, as well as increased confidence levels up to 9 and 10 in all technical aspects of the surgery, having 96% of the surgeons performed a surgery under supervision of the proctors after the course. Conclusion: This training model is simple, effective, low cost, and replicable in guidance on the beginning of e-tep technique adoption, and performance. As a result, surgeons can get more confident and more able to perform surgeries employing this technique.