Totally Endoscopic Sublay Repair for Postpartum Diastasis Recti Using Staplers: Surgical Technique and Preliminary Outcomes.

PURPOSE: Recently, staplers have been introduced for the management of diastasis recti; however, current literature primarily reports transabdominal or infraumbilical open approaches. This study aims to describe in detail a totally endoscopic sublay repair technique using staplers for diastasis recti and to present its preliminary clinical outcomes. METHODS: Clinical data were retrospectively analyzed from patients who underwent laparoscopic retromuscular mesh repair for postpartum diastasis recti using staplers at the Department of Hernia and Abdominal Wall Surgery, The First People's Hospital of Foshan, between September 2022 and January 2026. Collected variables included age, sex, body mass index, operative time, width of diastasis recti, intraoperative blood loss, postoperative complications, visual analog scale (VAS) pain score, length of hospital stay, recurrence rate, and follow-up findings. RESULTS: A total of 22 patients successfully completed the surgery. The mean inter-rectus distance was 4.04 cm (range: 2.9-8.0 cm). One patient with severe diastasis recti (8 cm) experienced intraoperative dislodgement of posterior sheath staplers due to high fascial tension, necessitating medial release of the posterior rectus sheath relative to the neurovascular bundles to reduce tension and achieve secure closure. Five patients underwent concomitant abdominoplasty following laparoscopic repair. The mean operative time was 190 minutes (range: 100-371 minutes), with a mean blood loss of 27.5 mL (range: 5-150 mL). The average length of hospital stay was 5.2 days (range: 3-8 days). Postoperatively, 4 patients (18.2%) developed seromas, all of which resolved with conservative management. No recurrences were observed during the follow-up period. CONCLUSIONS: Totally endoscopic sublay repair using staplers is a feasible, safe, and effective option for the correction of mild-to-moderate postpartum diastasis recti. While short-term outcomes are favorable, long-term efficacy and durability require validation through larger studies with extended follow-up.