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Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR)

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Abstract

Background

Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD.

Methods

A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4–10 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. The size of the flaps was estimated using a mathematical formula. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included patient demographics, operative parameters, and complications. A computerized tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma.

Results

Twelve patients were included. Mean width of the defect was 5.5 cm. Average VAS (24 h) was 3.9, 1.1 (1 month), and 0 (1 year). Mean preoperative distance between rectus was 5.5 cm; postoperative was 2.2 cm (1 year). Radiological seroma at first month was detected in 50%. Mean follow-up was 15 months.

Conclusion

The LIRA technique could be considered as an alternative to conventional CD or endoscopic component separation for medium defects under 10 cm in width. This technique obtained a “no tension” effect that could be related to a lower rate of postoperative pain with no recurrence or bulging, being a safe, feasible, and reproducible technique.

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Author notes

  1. Julio Gómez-Menchero MD

    Present address: , Juan de Zoyas 6, Portal 1, 41018, Seville, Spain

Authors and Affiliations

  1. Department of General Surgery, Riotinto General Hospital, Minas de Riotinto, Huelva, Spain

    Julio Gómez-Menchero MD, Juan Francisco Guadalajara Jurado, Juan Manuel Suárez Grau & Joaquin Luis García Moreno

  2. Department of General Surgery, University Hospital “Virgen Macarena”, Seville, Spain

    Juan Antonio Bellido Luque

  3. Unit of Innovation in Minimally Invasive Surgery, University Hospital “Virgen del Rocio”, Seville, Spain

    Isaías Alarcón del Agua & Salvador Morales-Conde

Authors
  1. Julio Gómez-Menchero MD
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  2. Juan Francisco Guadalajara Jurado
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  3. Juan Manuel Suárez Grau
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  4. Juan Antonio Bellido Luque
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  5. Joaquin Luis García Moreno
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  7. Salvador Morales-Conde
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Correspondence to Julio Gómez-Menchero MD.

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Disclosure

Julio Gómez-Menchero, Juan Francisco Guadalajara Jurado, Juan Manuel Suárez Grau, Juan Antonio Bellido Luque, Joaquín  Luis García Moreno, Isaías Alarcón del Agua, and Salvador Morales-Conde have no conflict of interest or financial ties to disclose.

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Gómez-Menchero, J., Guadalajara Jurado, J.F., Suárez Grau, J.M. et al. Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR). Surg Endosc 32, 3502–3508 (2018). https://doi.org/10.1007/s00464-018-6070-y

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