Subcutaneous onlay laparoscopic approach (SCOLA) for ventral hernia with concomitant diastasis recti: a single-center experience

Abstract

Abstract Background Despite advances in hernia repair techniques, high recurrence rates remain a major challenge; studies report rates as high as 31.2% when DR is not addressed. Diastasis recti (DR) raises the risk of hernia recurrence after midline ventral hernia repair. About 45% of patients with umbilical or epigastric hernias also present with DR. The subcutaneous onlay laparoscopic approach (SCOLA) is a minimally invasive surgical technique that provides simultaneous treatment of hernia and DR by plicating the separated muscles and reinforcing them with an onlay mesh. Objectives To evaluate the SCOLA technique as a safe, feasible, and effective approach for ventral hernia repair with concomitant diastasis recti. Specifically, we hypothesize that SCOLA is associated with acceptable 30-day morbidity, high patient satisfaction, and low early recurrence rates in this patient population. Methods In our study, we prospectively enrolled 12 consecutive patients in whom SCOLA repair was the procedure of choice for primary ventral hernia with diastasis recti at a single Omani center (Ibra Hospital, North Sharqiyah, Ministry of Health) from September 2024 to April 2025. The mean age was 40.2 ± 10.0 years. The mean BMI was 30.64 ± 3.41 kg/m 2 . The primary outcome was 30-day morbidity, classified by the Clavien-Dindo classification. Secondary outcomes were patient satisfaction and recurrence during follow-up. Results Mean operative time was 139.6 ± 36.7 min with minimal blood loss. Most patients had umbilical hernias (11/12, 91.7%) and W3 diastasis recti (12/12, 100%). Postoperative seroma occurred in 3/12 patients (25%, 95% CI 5–57%). All were Clavien-Dindo Grade I and managed conservatively. There were no infections, skin necrosis, or mortality. Mean patient satisfaction was 9.25 ± 1.48/10. One recurrence (1/12, 8.3%, 95% CI 0.2–38.5%) occurred at 5 months post-operatively, within the study follow-up period. Conclusions SCOLA appears safe and feasible for simultaneous ventral hernia and DR repair in selected patients, with acceptable early morbidity, high satisfaction, and low early recurrence. The small sample size, single-center methodology, and short follow-up period pose notable constraints on the strength and validity of the conclusions that can be drawn.