Laparoscopic endoscopic preaponeurotic repair (REPA) for rectus diastasis with concomitant ventral and umbilical hernias: a case report and literature review.

Abstract

Rectus diastasis frequently coexists with midline hernias, leading to abdominal wall dysfunction, bulging, and pain. Among surgical options, intraperitoneal onlay mesh (IPOM) and open plication are commonly used. The laparoscopic endoscopic preaponeurotic repair (REPA) has emerged as a minimally invasive alternative that avoids intraperitoneal mesh placement while restoring the linea alba and repairing associated hernia defects. A 68-year-old male presented with abdominal pain and bulging. Clinical examination and ultrasonography confirmed rectus diastasis associated with epigastric and umbilical hernias. The patient underwent laparoscopic REPA. The procedure involved laparoscopic dissection of the preaponeurotic space, reduction of hernia sacs, linea alba plication, and placement of a macroporous polypropylene mesh in the preaponeurotic plane. A Penrose drain was left in place and removed on postoperative Day 7. The patient was discharged on Day 2 and had an uneventful recovery. At 6 months, there was no recurrence, no seroma, and a good short-term outcome. Laparoscopic REPA is a safe and effective minimally invasive option for the treatment of rectus diastasis with associated midline hernias. Compared with IPOM or open repair, REPA combines functional restoration with low morbidity and favorable aesthetic results.