Minimally invasive abdominal wall surgery in Milan
REPA surgery in Milan for rectus diastasis
REPA is a minimally invasive endoscopic procedure designed to repair rectus diastasis and selected midline hernias through small suprapubic incisions, without the long scar of a traditional abdominoplasty.
Usually positioned above the pubic area
Reconstruction of the linea alba by plication
Placed outside the abdominal cavity
REPA always includes one night of hospitalization
What is REPA?
Endoscopic repair of the abdominal wall
REPA stands for Preaponeurotic Endoscopic Repair. The operation is performed in the plane in front of the rectus muscles, without entering the abdominal cavity. The surgeon restores the midline by suturing the anterior rectus fascia and reinforces the reconstruction with a lightweight mesh.
This anterior approach reproduces the functional principle of rectus plication used in abdominoplasty, but avoids the long lower-abdominal incision and extensive skin removal when these are not clinically necessary.
REPA is not simply an aesthetic procedure. It is abdominal wall surgery intended to correct an anatomical defect. Aesthetic improvement can be significant, but a correct diagnosis and patient selection remain essential.
How the procedure works
Four essential surgical steps
Small suprapubic incisions
Endoscopic instruments are introduced through small access points positioned low on the abdomen, usually below the underwear line.
Creation of the preaponeurotic space
The surgical plane is developed on the front surface of the abdominal muscles, allowing direct visualization of the linea alba and any associated midline hernia.
Repair of diastasis and associated hernias
The rectus fascia is brought back toward the midline. Selected umbilical, epigastric or linea alba hernias can be treated during the same operation.
Lightweight mesh reinforcement
A mesh is positioned in the preaponeurotic plane to support the repair. It remains outside the peritoneal cavity and does not come into contact with the bowel.
Patient selection
Who may be suitable for REPA?
REPA can be considered when the main problem is rectus diastasis, with or without a small associated midline hernia, and there is no major excess of skin requiring removal.
Persistent abdominal bulging
For selected patients whose abdomen remains prominent, weak or poorly supported despite weight stabilization and rehabilitation.
Umbilical or epigastric defects
Small midline hernias can often be repaired together with the diastasis during the same endoscopic procedure.
Avoiding a long abdominal scar
REPA may be appropriate when skin quality is compatible with a minimally invasive repair and a dermolipectomy is not required.
REPA is not the correct operation for every patient. Significant skin redundancy, a large abdominal apron, extensive previous surgery or specific anatomical findings may make MILA, abdominoplasty or another abdominal wall procedure more appropriate.
Clinical result
Abdominal contour before and after minimally invasive repair
The visible result depends on the starting anatomy, tissue quality, body composition and postoperative rehabilitation. The objective is both functional reconstruction and a more harmonious abdominal profile.
Clinical photographs show an individual case and are not a guarantee of an identical outcome. Every surgical result depends on the patient’s anatomy, tissue characteristics and adherence to postoperative instructions.
Hospital stay and recovery
What international patients should expect
REPA is performed under general anaesthesia and always includes one night of hospitalization. Discharge normally takes place the following day after clinical assessment.
- An abdominal compression garment is generally worn during the early recovery period.
- Strenuous activity, heavy lifting and sport must be avoided until surgical clearance.
- Drain management and wound checks are organized according to the individual case.
- Postoperative physiotherapy and hypopressive rehabilitation are an important part of functional recovery.
- International patients should remain in Milan for the period agreed during the consultation before travelling home.
The exact travel timetable cannot be standardized before the clinical assessment. It depends on age, associated conditions, the extent of repair and the planned journey.
Assessment pathway
In-person consultation or video consultation
In-person consultation in Milan
Direct clinical examination
Imaging is not routinely required before an in-person surgical visit. The abdominal wall, skin quality, distribution of fat and any suspected hernia are assessed directly.
Video consultation via Google Meet
Imaging required in advance
For a remote consultation, an abdominal wall ultrasound or preferably a CT scan must be sent beforehand, together with the report and relevant clinical documentation.
A personalized quotation and definitive surgical plan are provided only after the specialist assessment. A video consultation can establish an initial indication, while final confirmation may require direct examination before surgery.
Choosing the right operation
REPA, MILA or abdominoplasty?
Wall repair is the priority
Best considered when the main objective is minimally invasive correction of rectus diastasis and selected midline hernias, without major skin removal.
Repair plus advanced contouring
Combines diastasis repair with VASER liposculpture and, when indicated, Quantum RF skin tightening for more complete three-dimensional remodelling.
Major skin excess must be removed
May be necessary when there is a substantial abdominal apron or skin redundancy that cannot be adequately treated through a minimally invasive approach.
Experience and scientific evidence
REPA introduced in Europe by Dr. Cuccomarino in 2017
Dr. Salvatore Cuccomarino performed the first REPA procedure in Europe in 2017 and has developed one of the largest international clinical experiences with this technique. His published single-surgeon series in Surgical Endoscopy included 172 patients and reported REPA as a safe and effective alternative for selected patients with rectus diastasis.
Local care in Milan
Consultation and surgery in central Milan
The pathway for international patients can begin remotely and continue with consultation, preoperative assessment, surgery and postoperative checks in Milan.
Consultations
Centro Medico Visconti di Modrone
Via Visconti di Modrone 7
20122 Milan, Italy
Surgery
H San Raffaele Resnati · Punto RAF Santa Croce
Via Santa Croce 10/A
20122 Milan, Italy
Frequently asked questions
Questions about REPA surgery
Does REPA always require an overnight hospital stay?
Yes. In Dr. Cuccomarino’s protocol, REPA always includes one night of hospitalization, with discharge after the postoperative clinical assessment.
Do I need an ultrasound or CT scan before the consultation?
Not before an in-person consultation. Imaging is required in advance only for a video consultation, using an abdominal wall ultrasound or preferably a CT scan.
Can REPA repair an umbilical hernia at the same time?
Selected umbilical, epigastric and linea alba hernias can often be treated during the same procedure. Suitability depends on their size, location and anatomical characteristics.
Will REPA remove loose skin?
REPA repairs the abdominal wall but does not remove a large amount of skin. When laxity or localized fat also requires treatment, MILA or another tailored procedure may be more appropriate.
How long should I remain in Milan after surgery?
The necessary stay is defined after assessment and depends on the extent of surgery, general health and travel plans. International patients should not arrange their return journey until the postoperative timetable has been agreed.
Can I receive a surgical quotation by email?
A personalized quotation is issued only after a surgical consultation, because the correct procedure and associated treatments vary from one patient to another.
International patient pathway
Find out whether REPA is appropriate for you
Send a brief clinical history, any previous abdominal operations and your preferred consultation method. The surgical team will explain the next steps for assessment in Milan or by Google Meet.