Indications
- rectus diastasis
- midline ventral hernias
- umbilical hernia
- epigastric hernia
- midline incisional hernias
- recurrent hernias
- diastasis combined with midline hernias
miSAR® is not the right technique for everyone, however. The choice depends on the size and site of the defect, the anatomy of the abdominal wall and BMI. Who is miSAR® for
small incisions below the underwear line, scars not visible
How the miSAR® procedure is performed
- IEntry into the peritoneal (miSAR®) or preperitoneal (p-miSAR®) space
Access is gained through small pelvic ports.
- IIPreparation of the retromuscular space
A space is created behind the rectus muscles, between the muscle and the posterior fascia. This plane allows the reconstruction to be performed and provides a protected anatomical space for the mesh: the mesh is not left free in the abdominal cavity but is placed behind the muscles.
From top: skin, subcutaneous tissue, anterior fascia, rectus muscle, mesh, posterior fascia, peritoneum, bowel loops. - IIIMechanical reconstruction of the midline
This is the distinctive step of miSAR®: closure of the midline defects and approximation of the muscles with a stapled suture. Many small, evenly spaced stitches → even distribution of tensile force.The reconstruction does not involve the hernia opening alone: it addresses the midline as a whole.Download the article on mechanical reconstruction · PDF
Stapled suture: evenly spaced stitches along the midline. - IVReinforcement of the anterior suture
The anterior suture line is further reinforced with a hand-sewn suture, which also allows the navel to be inverted.
- VPlacement of the retromuscular mesh
At the end of the reconstruction a mesh is placed in the retromuscular plane to reinforce the rebuilt wall. The mesh therefore lies: rectus muscle→mesh→posterior fascia→peritoneum→bowel
Retromuscular mesh during miSAR® reconstruction.
Waistline
Reconstructing the posterior compartment makes it possible to restore and enhance the waistline and to treat any associated lateral diastasis.
Laparoscopy or robotics?
The instruments are introduced through small ports and handled directly by the surgeon, who watches the operating field on a monitor.
In the robotic variant the surgeon controls articulated instruments from the console, with a three-dimensional view of the operating field.
The reconstructive principle stays the same: only the platform used to achieve it changes.
Learn moreRobotic surgerymiSAR® and p-miSAR®: what is the difference?
p-miSAR® keeps the reconstructive principles of miSAR® but is performed through an extraperitoneal/preperitoneal approach, avoiding access to the peritoneal cavity whenever possible.
The difference mainly concerns the access plane, which makes it possible to reinforce the wall down to the pubis without ever placing an intraperitoneal mesh.
- miSAR®
- Mechanical midline reconstruction + retromuscular mesh.
- p-miSAR®
- Same reconstructive principle with extraperitoneal/preperitoneal development.
Plastic surgery
Possible combination with plastic surgery
Where indicated, functional reconstruction can be combined with aesthetic remodelling of the abdominal wall performed by the plastic surgery team.
When, in addition to the functional repair of the wall, treatment is also needed for:
- excess skin
- fatty apron
- abdominal contour
- scars
Timing and hospital stay
- About 2h30
Duration of surgery
- 1 night
Hospital stay
Post-operative recovery
immediate
- Straight awayImmediate return to daily life
- ≈ 40 daysStart of abdominal and pelvic rehabilitationRehabilitation after surgery
- After 90 daysGradual return to all physical activity, including weights
Day-to-day recovery is quick; biological healing of the abdominal wall takes longer.
Learn moreRecovery after diastasis surgeryA technique developed and published
miSAR® is a technique developed by Dr Gabriele Manetti and subsequently the subject of scientific publications and surgical training, with dedicated courses and live surgery sessions.
Frequently asked questions
What does miSAR® mean?
miSAR® stands for Minimally Invasive Stapled Abdominal Reconstruction, a minimally invasive reconstruction of the abdominal wall using a stapled suture.
Does miSAR® also correct diastasis?
Yes. The technique was developed to reconstruct the midline, bringing the rectus muscles back together and treating any associated hernia defects at the same time.
Is the mesh in contact with the bowel?
No. In miSAR® the mesh is placed in the retromuscular plane, behind the rectus muscles and separate from the abdominal organs.
Can miSAR® be performed robotically?
Yes. The technique can be performed either laparoscopically or with a robotic platform. In the robotic variant the reconstructive principle stays the same: only the instrument used to achieve it changes.
How long does the operation take?
The average duration is about 2 hours and 30 minutes, but it can vary depending on the complexity of the abdominal wall, the presence of multiple defects, adhesions, previous surgery or associated procedures.
How long is the hospital stay?
In standard cases one night in hospital is generally planned, with early mobilisation and an early return to daily life.
Is miSAR® suitable for all patients with diastasis?
No. The technique is chosen only when it suits the patient's anatomical and clinical features. Defect size and site, tissue quality, the presence of hernias, BMI and previous surgery may point towards miSAR®, p-miSAR® or other techniques.
When can I return to sport after miSAR®?
Daily life is resumed quickly, but the fascial reconstruction needs a period of biological healing. The return to physical activity must therefore be gradual and respect the time needed for scarring.
Would you like to know whether miSAR® suits your case?
The choice of technique depends on the type of diastasis, the presence of hernias, previous surgery and the characteristics of the abdominal wall. A specialist assessment shows whether miSAR® is really indicated or whether another reconstruction may be more appropriate.