Subcutaneous Onlay Laparoscopic Approach (SCOLA) for Swiss-Cheese Hernias Following Thoracoabdominal Incision: A Case Report

Abstract

Swiss-cheese hernias, characterized by multiple small defects along a single incision, pose significant challenges after thoracoabdominal procedures. Although the Subcutaneous Onlay Laparoscopic Approach (SCOLA) is effective for midline ventral hernias and rectus abdominis diastasis, its role in non-midline incisional hernias remains underexplored. We present a 61-year-old male with multiple Swiss-cheese hernias along a thoracoabdominal incision following thoracic aortic aneurysm repair. CT revealed three defects: left subcostal (1.9 cm), left lumbar (1.5 cm), and left paramedian (0.3 cm). SCOLA was performed using pre-aponeurotic dissection, primary closure with non-absorbable barbed sutures, and reinforcement with overlapping polypropylene meshes. The patient recovered uneventfully, was discharged on postoperative day three, and remained free of recurrence or chronic pain at 8 months. This case highlights SCOLA's feasibility for complex non-midline incisional hernias, offering a minimally invasive approach that reduces mesh-related complications and postoperative pain, particularly in subcostal defects.