Long-term outcomes of repa for ventral hernias and diastasis: recurrence risk and aesthetic challenges

To evaluate outcomes of the REPA technique in patients with midline ventral or incisional hernias and associated diastasis during long-term follow-up, complemented with computed tomographic (CT) imaging.

A retrospective study including patients who underwent REPA surgery between November 2017 and April 2024 was performed. Demographic data, operative times, postoperative complications, and hospital stay were analyzed. Functional and aesthetic outcomes were assessed using the EHS quality-of-life score. Patients with more than one year since surgery underwent a CT. Based on CT results, patients were divided into two groups to compare (recurrence/no recurrence).

A total of 142 patients underwent REPA. The associated diastasis had a mean size of 33.8 ± 13.3 mm. The median follow-up time was 47.9 ± 23.97 months. 62 patients completed the EHS-QoL questionnaire. Regarding aesthetics, the general shape of the abdomen had a mean score of 5.66 (± 3.55) and the hernia site and scar scored 3.37 (± 3.58). Among the 33 patients who underwent follow-up CT scans, recurrence was identified in 9 cases (27.3%). Statistically significant differences were observed in BMI (26.01 ± 5.45 vs. 30.52 ± 4.99 kg/m², p = 0.04) and diastasis size (30.3 ± 8.95 vs. 56.6 ± 17.4 mm, p < 0.001) between patients with and without recurrence.

Our findings suggest a higher risk of recurrence in patients with diastasis > 5 cm and obesity, highlighting the need for careful patient selection. Furthermore, overall abdominal shape may be unsatisfactory despite minimal scarring. Overweight and obesity should be considered exclusion criteria to optimize functional and aesthetic outcomes.