SubCutaneous OnLay endoscopic Approach (SCOLA) for midline ventral hernias associated with diastasis recti

Minimally invasive surgery for diastasis recti has gained attention in the recent past, with several reports with different names and particularities being suggested by the authors. SCOLA (Subcutaneous OnLay endoscopic Approach) is an example of this technique, described here in standardized technique.

Basic steps to perform the procedure are detailed, beginning with patient and surgical team positioning, including trocar placement and tips and tricks of the subcutaneous dissection, steps needed to achieve full dissection of the preaponeurotic space, diastasis recti plication, mesh positioning and fixation and drain positioning with fixation of the umbilical stalk.

Regardless of different names and small technical variations, endoscopic pre-aponeurotic mesh positioning can be performed with well-established steps on a reproducible fashion, aiming to achieve better results. Careful attention should be paid to appropriate patient selection and drain placement to reduce seroma rate, the most common complication.