Subcutaneous onlay laparoscopic approach for ventral hernia and rectus abdominis diastasis repair: a case series

Ventral hernia repairs have been posing a major aesthetic problem over the years giving rise to cosmetically unpleasing scars, significant post-operative pain and an array of post operative complications including post-operative adhesive obstruction and recurrence .Surgical repair of these hernias can be done either by open or laparoscopic methods .The standard open approach is associated with higher chances of flap necrosis, seroma, wound and mesh infection, the incidence of which increases with increasing size of defect ,age of the patient and associated comorbidities. The advent of minimal access surgery has refurbished ideas and techniques associated with the repair of ventral hernias and one such novel technique developed as an extrapolation of the open onlay mesh repair is subcutaneous onlay laparoscopic repair (SCOLA). The technique described by Claus and Malcher integrates subcutaneous onlay laparoscopic mesh repair with plication of the rectus diastasis, which has long been acknowledged as a significant contributor to recurrence when left unaddressed. The success of this procedure lies in overcoming the limitations of other hernia repairs by being minimally invasive, ergonomically favourable, minimizing risk of bowel injury with better cosmetic outcomes. The aim of the article is to describe our experience in this relatively novice technique and understanding the advantages and shortcomings in order to improve patient’s outcome.