## 4 Discussion
The plication was performed after a totally endoscopic subcutaneous approach (which differs from the other two approaches that begin with a mini-open procedure). In this study, ultrasound was used to determine inter-rectus distances and recurrences at the xiphoid, 3 cm supraumbilical and 2 cm subumbilical sites. [PERSON] et al. [28] and [PERSON] et al. [29] used a suprapublic endoscopic approach called preaponeurotic endoscopic repair (REPA). This localization provides a better overview of the supra- or preaponeurotic space and the linea alba, allowing for hernia repair if necessary. Recti plication was performed with a barbed suture and reinforced with polypropylene mesh. A drainage was systematically left out. [PERSON] et al. [30] described a similar approach to the video-parietoscopic surgery of the abdominal wall. Using a supra-public or umbilical approach, depending on the location of the lesion, the aponeurotic space was released endoscopically and the pathological zones were repaired using standard endoparietal sutures or percutaneous sutures with a Reverdin needle. The plication of diastasis may result in extensive tension, in which case it is necessary to reduce the tension by dividing the fascia of the external oblique muscle near the semilunar line, thus medializing the rectus abdominis muscle (component separation). [PERSON] et al. [31] first described this technique and achieved up to 10 cm of unilateral rect advancement. The laparoscopic approach preserves the rectus abdominis perforators, supplying the overlying skin and the connection between the subcutaneous fat and the anterior rectus sheath, thereby reducing subcutaneous dead space and potentially improving the vascularity of the overlying skin flap [29; 32]. Although reports of component separation in children are less common, it has been described in the treatment of children with giant omphalocele. [PERSON] et al. [33] even used CST in the operative repair of large abdominal wall defects in infants and children, such as gastroschisis or omphalocele, and showed that CST can be a very useful technique for children with a loss of abdominal domain. [PERSON] et al. [34] used CST with a double-layered biological mesh placement for neonates with large gastrocnemius. [PERSON] et al. [35] described an extended component separation that facilitated the mobilization of the rectus abdominis muscle along its costal insertion to close an upper midline defect in a child with a giant omphalocele, who had previously undergone traditional component separation. [PERSON] et al. [36] found no adverse physiological effects and a normalization of abdominal muscle thickness over time. Since CST has been used in combination with the plication of diastasis recti and has shown no physiological effects in children, we suggest that it could be used in children with marked DRA. To date, no other report has described the use of an epifascal approach in pediatric DRA surgery as it has been carried out in adults. [PERSON] et al. [37] reported the use of the open method for an epigastric incisional hernia closure after a laparoscopic only mesh placement (IPOM procedure). However, laparoscopic repair has also been reported for ventral hernia repair in children. [PERSON] et al. [38] described a novel laparoscopic technique for umbilical and epigastric hernis consisting of an intraperitoneal defect suturing of the fascia with non-absorbable Ethibond 2-0 and extraperitoneal knots tying to close the defect. Other approaches include single-incision laparoscopic surgery (SILS) or single-incision pediatric endoscopic surgery (SIPES). Both have shown excellent results in pediatric hernia repair [39; 40]. We did not observe any serious or life-threatening complications with our method. In our study, all subjects showed a clinical regression of rectus diastasis without abdominal wall protrusion and a good improvement of symptoms. One patient developed a mild thermal injury due to the preparation of the epifascal cavity with utlracision.