Subcutaneous onlay laparoscopic approach (SCOLA) in the treatment of epigastric hernia in an obese patient: a feasible minimally invasive option – a case report and literature review

Abstract

Introduction Primary ventral hernias are a common surgical entity, with epigastric hernias representing a specific subtype. The evolution of minimally invasive surgery has led to the development of various techniques, including the subcutaneous onlay laparoscopic approach (SCOLA). This report aims to present a case of an epigastric hernia in an obese patient successfully treated with the SCOLA technique and to review the relevant literature.

Case outline A 31-year-old female patient with a body mass index of 36.7 kg/m² presented with a symptomatic epigastric hernia. The diagnosis was confirmed by clinical examination and ultrasound, which revealed a 4.3 cm fascial defect containing preperitoneal fat. The patient underwent elective SCOLA repair. The procedure involved creating a subcutaneous working space above the anterior rectus sheath, hernia sac reduction, primary closure of the fascial defect, and placement of a TiO₂ mesh fixed to the anterior rectus sheath. The surgical procedure was completed successfully without intraoperative complications. The patient was discharged on the first postoperative day. On day 14, the skin sutures were removed, revealing a well-healed wound. Follow-up examinations at three, six, and 12 months revealed no evidence of recurrence or mesh-related complications.

Conclusion The SCOLA technique represents a safe and effective minimally invasive option for the treatment of primary epigastric hernias, particularly in obese patients. It combines the benefits of mesh reinforcement with a completely extraperitoneal and extrafascial position, avoiding intra-abdominal mesh placement and its associated risks.

Keywords: epigastric hernia; SCOLA; minimally invasive surgery; ventral hernia; obesity