Clinical and functional outcomes after endolaparoscopic stapled repair of rectus abdominis diastasis combined with midline defects: A multicentric prospective observational cohort study

Background: Surgical repair of abdominal wall midline defects combined with rectus abdominis diastasis is still controversial. Studies conducted with scientific rigor reporting clinical and functional outcomes are few and mostly based on small series. This study aims to analyze the clinical and functional outcomes of a stapled endolaparoscopic technique (Trentino Hernia Team technique) for midline reconstruction in a cohort of patients affected by abdominal wall midline defects (primary and incisional) and diastasis recti. Methods: Prospective multicenter observational cohort study of 259 consecutive patients treated with endolaparoscopic reconstruction of the abdominal wall using linear staplers. Clinical and radiological follow-up data were collected on morbidity and relapse rates at 1, 6, 12, and 24 months after the operation. Data related to the patient's quality of life, urinary stress incontinence, and chronic low back pain were collected preoperatively and at 1 and 6 months after surgery. Results: After a mean follow-up of 20.9 months, the total morbidity rate was 14.3%, with only 2.3% Clavien-Dindo >IIIa complications. Nine posterior rectus sheath disruptions (3.5%) and 1 recurrence (0.4%) were recorded, with no differences between the 2 subgroups treated with synthetic or biosynthetic meshes. The mean inter-recti distance 2 years after surgery was 0.8 cm. Six months after surgery, EuraHSQol, Oswestry Disability Index, and Incontinence Severity Index scores significantly improved. Conclusion: The Trentino Hernia Team technique was proven to be a safe and effective alternative for corrective surgery of primary midline hernias associated with rectus diastasis, significantly improving patients' perceived quality of life.