Totally Endoscopic Sublay Anterior Repair (TESAR) for diastasis recti, primary and incisional ventral hernias: Long-term clinical outcomes and quality of life

Purpose: Abdominal midline defects, like diastasis recti (DR), primary and incisional ventral hernias, significantly impair function and quality of life. Minimally invasive abdominal wall reconstruction is increasingly shifting toward extraperitoneal approaches. This study aimed to evaluate the safety, efficacy, and long-term outcomes of Totally Endoscopic Sublay Anterior Repair (TESAR), an anterior completely extraperitoneal technique, through a retrospective observational analysis. Methods: Consecutive adult patients undergoing TESAR for DR and/or primary and/or incisional midline ventral hernias between January 2018 and March 2025 were included. The primary endpoint was the 30-day postoperative complication rate. Secondary endpoints included length of stay, recurrence, and quality of life (QoL), assessed by EuraHS-QoL and Carolinas Comfort Scale (CCS) up to 12 months. Recurrence was assessed clinically at scheduled visits or via telemedicine and by imaging (ultrasound or CT). The impact of technical refinements, including subcutaneous quilting suture, was analyzed. Results: A total of 120 patients were analyzed, with a median follow-up of 31 months. Indications included DR with umbilical hernia in 83 patients (69.2%), incisional hernias in 39 patients (32.5%), and other primary hernias in 15 patients (12.5%). No intraoperative complications occurred. Median follow-up was 31 months (range 12–81, IQR 18–54.5). Postoperative morbidity was 6.7% (seroma 5%, hematoma 1.6%), with no surgical site infections. No recurrences were clinically detected during follow-up. Quilting suture reduced clinically relevant seromas to 0%. Median hospital stay was 3 days. EuraHS-QoL scores improved from a median of 57 preoperatively to 0 at 12 months, and CCS scores from 35.5 to 0. Conclusion: TESAR appears to be a safe and effective minimally invasive technique for selected patients, associated with low morbidity and significant improvement in QoL. However, given the retrospective, observational and non-comparative design, these findings should be interpreted cautiously. Further prospective comparative studies are warranted.