Management of diastasis recti (DR), especially associated with abdominal hernias, has gained attention from general surgeons in recent years not only due to the effect of DR in increasing the risk of hernia recurrence but also due to better understanding of the functionality of the abdominal wall. In addition, minimally invasive techniques have brought new possibilities for this type of repair, especially for patients without excess skin, a condition in which conventional abdominoplasty has less appeal. In this scenario, SCOLA (SubCutaneous Onlay Laparoscopic Approach) seems to be an attractive alternative. The main advantages of this approach are the excellent aesthetic result, low risk of serious, wound complications, and technical simplicity. Steps of procedure are detailed, including patient and surgical team positioning, trocar placement, tips and tricks of the subcutaneous dissection, steps needed to achieve full dissection of the preaponeurotic space, DR plication, and mesh positioning and fixation. Careful attention should be paid to appropriate patient selection and drain placement to reduce the seroma rate, the most common complication. Indication and perioperative management are also itemized.

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Subcutaneous Onlay Laparoscopic Approach (SCOLA)

  • Christiano Claus,
  • Flavio Malcher,
  • Leandro Totti Cavazzola

摘要

Management of diastasis recti (DR), especially associated with abdominal hernias, has gained attention from general surgeons in recent years not only due to the effect of DR in increasing the risk of hernia recurrence but also due to better understanding of the functionality of the abdominal wall. In addition, minimally invasive techniques have brought new possibilities for this type of repair, especially for patients without excess skin, a condition in which conventional abdominoplasty has less appeal. In this scenario, SCOLA (SubCutaneous Onlay Laparoscopic Approach) seems to be an attractive alternative. The main advantages of this approach are the excellent aesthetic result, low risk of serious, wound complications, and technical simplicity. Steps of procedure are detailed, including patient and surgical team positioning, trocar placement, tips and tricks of the subcutaneous dissection, steps needed to achieve full dissection of the preaponeurotic space, DR plication, and mesh positioning and fixation. Careful attention should be paid to appropriate patient selection and drain placement to reduce the seroma rate, the most common complication. Indication and perioperative management are also itemized.