SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOLA) FOR VENTRAL HERNIA AND RECTUS ABDOMINIS DIASTASIS REPAIR: TECHNICAL DESCRIPTION AND INITIAL RESULTS

ABSTRACT Background: Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. Aim: To describe a “new” technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. Method: SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. Results: The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. Conclusion: The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.

摘要
背景：腹直肌分离（Diastasis of the rectus abdominis muscles, DMRA）较为常见，常与腹壁疝伴发。对于存在皮肤冗余的患者，皮肤脂肪切除术联合腹直肌分离折叠术是临床最常用的术式。然而，有相当一部分患者无需接受皮肤切除，或不愿接受大切口手术。
目的：本研究旨在介绍一种用于矫正腹壁疝并联合腹直肌分离折叠术的“新型”技术——皮下平铺腹腔镜术式（subcutaneous onlay laparoscopic approach, SCOLA），并报告该病例系列的初步临床结果。
方法：本研究对48例需同时行腹直肌分离折叠术的腹壁疝患者，采用腱膜前内镜技术，通过皮下平铺腹腔镜术式实施矫正手术。
结果：手术平均时长为93.5分钟。无术中并发症，亦无中转开腹情况。血清肿是最常见的术后并发症（n=13，占比27%）。仅1例（2%）患者出现手术切口感染。中位随访时长为8个月（范围2~19个月），仅1例（2%）患者出现腹直肌分离复发，1例（2%）出现皮下组织回缩/纤维化。45例（93.7%）患者对手术效果表示满意。
结论：SCOLA术式是治疗合并腹直肌分离的腹壁疝患者的一种安全、可重复且有效的替代方案。