Subcutaneous onlay laparoscopic approach versus laparoscopic intraperitoneal onlay mesh repair of ventral hernia and correction of rectus diastasis: randomized controlled study

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Abstract

Background
The association between ventral hernia and rectus abdominis diastasis is a common condition especially in multiparous women. Hernia correction alone without midline reinforcement increases the risk of hernia recurrence. Subcutaneous onlay laparoscopic approach (SCOLA) is a new minimally invasive procedure that allows the surgeons to do simultaneous correction of rectus diastasis and hernia mesh repair with low cost without the need for large transverse abdominal incision.
Patients and methods
50 patients with non-complicated ventral hernia associated with rectus diastasis without significant redundancy in the skin of the abdominal wall were allocated randomly in 2 groups. 25 patients underwent SCOLA, and 25 patients underwent intraperitoneal on-lay mesh (IPOM) repair. Both techniques were compared as regard operative time, hospital stay, intra and postoperative complications, and recurrence rate.
Results
IPOM group experienced shorter operative time than SCOLA (115.27±10.54 vs 77.48±12.72) with no significant difference as regard intraoperative complications between both techniques. Although early postoperative pain was significantly less in SCOLA patients (=0.021), IPOM group had earlier restoration of normal daily activities (< 0.001). No significant recurrence rate was considered in both groups apart from one case (4%) after IPOM repair.
Conclusion
SCOLA could be a good choice in the concurrent repair of ventral hernia and rectus diastasis without significant postoperative complications. In addition, the use of regular proline mesh instead of composite mesh significantly decreases the economic burden.

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