Subcutaneous onlay laparoscopic approach or preaponeurotic endoscopic repair for laparoendoscopic treatment of rectus abdominis diastasis and concomitant ventral hernia

Summary Background Diastasis of the rectus abdominis muscles (DRAM) is considered as a divergence of the rectus abdominis muscles associated with a contemporaneous widening of the linea alba. When this distance exceeds 2 cm, the condition is defined as diastasis. Several surgical treatments have been proposed for correction, including endoscopic methods. The aim of our study was to review the available results of endoscopic procedures in the “onlay” space between the subcutaneous tissue and the anterior rectus sheat. Methods This systematic review was conducted via a comprehensive search in the PubMed, Web of Science, and Scopus databases. A total of 374 patients divided between 8 articles were included in the final meta-analysis. For each patient, we investigated the presence of DRAM associated with abdominal hernias as well as its surgical treatment, postoperative complications, and follow-up. Results All patients underwent laparoscopic treatment for DRAM and ventral hernias. Female patients predominated. Mean age of the patients was 45.86 years. Mean body mass index (BMI) was 25.70 kgm -2 , ranging from 17.6 to 40 kgm -2 . We found 187 patients with umbilical or paraumbilical hernias; 51 with epigastric hernias; 35 with incisional, trocar-site, or recurrent hernias; 37 with combined hernias; and 64 patients were described as having “ventral hernias” without further specification. Six patients had intraoperative bleeding. Postoperative hematoma occurred in 8 cases. We also found 83 cases of postoperative seroma formation. Wound infection occurred in 7 cases and mesh infection in only one patient. Overall, 13 cases of diastasis recurrence and one case of hernia recurrence were documented. Conclusion REPA (PreAponeurotic Endoscopic Repair), SCOLA (SubCutaneous Onlay Laparoscopic Approach), and SVAWD (Subcutaneous Videosurgery for Abdominal Wall Defects) represented valid, safe, and effective techniques, considering that no major complications occurred in our analysis group. We also observed a low rate of hernia or diastasis recurrence and a reasonable postoperative length of stay.