Short-term and long-term morbidity of endoscopic preaponeurotic repair of diastasis recti associated or not with midline hernia: prospective, multicenter and international study

Introduction and objective: Diastasis recti is a dysfunction of the linea alba due to abnormal intermuscular sepa-ration, predisposing to hernial defects and extraparietal manifestations. Endoscopic preaponeurotic repair is a surgical option that is not exempt from complications. Long-term morbidity is poorly understood. The main objective of the study is to know the long-term morbidity of the procedure.Methods: Prospective, multicenter and international study, between April 2014 and April 2019. 502 patients operat-ed on for diastasis recti associated or not with linea alba hernias using endoscopic preaponeurotic repair were included.Results: The size of the intraoperative RD was 46.93 mm & PLUSMN; 16.27, with 97.5 % associated with linea alba hernia. Linea alba restitution was performed by plication with barbed suture and was reinforced with macroporous polypro-pylene mesh in all patients. Intraoperative morbidity was 3.4 % and early postoperative morbidity 15.5 %: seromas 10.6 %, hematomas 1.6 %, cellulitis 1.2 % and omphalitis 1.1 %. No pain at 6 months. Late morbidity was diastasis recti recurrence in 0.8 % at a mean follow-up of 52 months.Conclusions: Diastasis recti is a pathology that can be safely corrected using the endoscopic preaponeurotic repair technique. Morbidity is very low; the most frequent complication is a seroma and the recurrence accounts for less than 1 %. A correctpre-surgical preparation, a refined technique and an adequate postoperative management allow to reduce morbidity and recurrence.