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Subcutaneous Onlay Laparoscopic Approach (SCOLA) for Swiss-Cheese Hernias Following Thoracoabdominal Incision: A Case
Amirah Lotfi Hanis1, Sidi Nurazim1, Sze Li Siow1,2,3
1Department of General Surgery, Hospital Umum Sarawak, Ministry of Health Malaysia, Kuching, Malaysia.
Asian Journal of Endoscopic Surgery
|April 21, 2025
Summary
The Subcutaneous Onlay Laparoscopic Approach (SCOLA) shows promise for treating complex Swiss-cheese hernias after abdominal surgery. This minimally invasive technique reduced recurrence and pain in a challenging case.
Area of Science:
- Hernia Surgery
- Minimally Invasive Procedures
- Laparoscopic Surgery
Background:
- Swiss-cheese hernias, multiple defects along one incision, complicate thoracoabdominal surgery recovery.
- The Subcutaneous Onlay Laparoscopic Approach (SCOLA) is established for midline hernias but less studied for non-midline incisional hernias.
Observation:
- A 61-year-old male presented with Swiss-cheese hernias post-thoracic aortic aneurysm repair.
- CT identified three defects: left subcostal (1.9 cm), left lumbar (1.5 cm), and left paramedian (0.3 cm).
Findings:
- SCOLA was successfully applied using pre-aponeurotic dissection and barbed sutures.
- Overlapping polypropylene meshes reinforced the repair, leading to uneventful recovery and discharge on postoperative day three.
Implications:
- This case demonstrates SCOLA's feasibility for complex, non-midline incisional hernias.
- The approach may minimize mesh complications and postoperative pain, especially for subcostal defects.
Keywords:
laparoscopic hernia repairmesh reinforcementminimally invasive surgerynon‐midline ventral hernia (NMVH)pre‐aponeurotic dissectionsubcutaneous onlay laparoscopic approach (SCOLA)swiss‐cheese herniathoracoabdominal incisional hernia
