Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: Why so many different names for the same procedure? A qualitative systematic review

Malcher, Flavio; Lima, Diego Laurentino; Cavazzola, Leandro Totti; Claus, Christiano Marlo Paggi; Dong, Caroline; Sreeramoju, Prashanth

doi:10.1007/s00464-021-08560-5

Cited by 20 publications

(9 citation statements)

References 27 publications

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“…Studies of similar procedures available in literature by Claus et al, Muas et al, and Kockerling et al have shown a 5-40% recurrence rate. Kler et al observed seroma formation in 80% of their patients, which can be attributed to the use of a larger use of biologic mesh [ 13 - 14 ]. Figure 7 depicts umbilical skin necrosis in which the above modification of SCOLA was not followed.…”

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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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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“…However, with more and more researches and studies, a deeper understanding of DRA has been gained. 12 , 25 DRA is one of the common complications during pregnancy and postpartum periods. It can appear around 14 weeks of pregnancy and gradually worsen until delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, surgery has been considered an effective treatment for DRA. 25 While depending on the understanding of DRA, non-surgical treatment and/or early active intervention methods are another effective way to treat DRA. 13 Simultaneously, parturients regular abdominal exercises and aerobic exports, pelvic floor muscle exercise, posture and back care, corsets, acupuncture treatment, and other methods have all been recommended as efficient non-surgical interventions for DRA treatment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women

Hu¹,

Gu²,

Yu³

et al. 2021

IJGM

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Purpose The incidence of diastasis rectus abdominis (DRA) in parturients is continuously increasing, which may cause uncomfortable and affect the quality of life. The present study aims to retrospectively summarize the experience and efficacy in the treatment of DRA via standardized rehabilitation procedures in Eastern China. Methods This retrospective study included the parturients with DRA admitted to the Xishan People’s Hospital of Wuxi between January 2017 and May 2021. Patients were separated into standardized rehabilitation group (SR) and non-standardized rehabilitation group (non-SR). The outcomes were the change in rectus abdominis separation and Physical Functioning Scale (PFS). Measurement data were compared between the two groups, and multivariate linear regression was used to analyze the factors associated with the standardized rehabilitation process. P values < 0.05 were considered statistically significant. Results Among a total of 294 patients with DRA who were included in the study, 171 patients were treated with SR (SR), and the other 123 patients were treated without SR process (non-SR). Compared with non-SR, the separation of the rectus abdominis was significantly reduced in SR after standardized rehabilitation treatment (p value < 0.0001). The multiple linear regression model analysis results suggested that standardized rehabilitation was an independent factor influencing the prognosis of DRA in parturients ( p < 0.0001). In addition, the quality of life of the study group was significantly improved ( p < 0.0001). Conclusion Standardized rehabilitation method revealed high efficiency in treating DRA in postpartum women and could improve the quality of life of parturients.

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“…Among other complications, hematoma, surgical site infection, and post-operative pain are uncommonly reported by the authors. Skin ischemia is a concern; however, it has rarely been described, because the lateral vascular vessels are generally preserved [20]. According to Muas D. hypoanesthesia occurs in 100% of patients in the immediate postoperative period, but total recovery sensitivity occurs from the periphery nerves between 2 and 6 months after surgery, without any sequelae [13].…”

Section: Discussionmentioning

confidence: 99%

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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Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: Why so many different names for the same procedure? A qualitative systematic review

Cited by 20 publications

References 27 publications

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

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

Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women

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

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