Robotic assisted subcutaneous onlay endoscopic approach (SCOLA) repair of superior recurrence after open transversus abdominis muscle release: a case report

There is a paucity of data on the use of the subcutaneous onlay laparoscopic approach (SCOLA) for management of recurrent incisional hernia after transversus abdominis release (TAR), particularly in patients with higher BMI and a hostile abdomen. Our patient is a 60-year-old woman with obesity and a complex surgical history resulting in a large M2–4 W3 R1 incisional hernia underwent open TAR and subsequently developed a symptomatic, bowel-containing superior recurrence. A robotic SCOLA approach was selected to avoid relaparotomy in a hostile abdomen. The defect was closed with a permanent barbed suture, and a 20-cm-wide lightweight polypropylene mesh was placed in an onlay position. This case report is the first to describe use of SCOLA to treat such a recurrence in a comorbid patient with a high BMI and a hostile abdomen. SCOLA is a viable option and should be considered in this unique patient population.