V-043 New Concepts in Lira Technique in Laparoscopic Ventral Hernia Repair. Lira -Less Step by Step

Abstract

Introduction LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) described in 2018 by our group showed advantages in preliminary results in terms of recurrence and bulging because a reduced tension in the midline in W2 defects following the EHS Classification. Otherwise permanent fixation in inlay meshes is related with and increase of pain and adhesions. We present LIRA-LESS step to step as an evolution in LIRA technique. Material and methods A 58 years old male affected by a M3W2 hernia. A LIRA procedure is proposed. Step 1: adhesions release and sac content reduced. Step 2: defect measurement and flap designed following the LIRA Technique principles with the neumoperitoneum deflated and flap mobilized and suture in the midline. Step 3 An in lay mesh of PVDF is positioned reducing permanent fixation in cardinal points combined with Cianocrilate in a 3:1 way. Step 4 A TAP-block anesthesia is performed in this case with Ropivacaine 2%. Results Operative time was 95 min. VAS 1 day was 3 and was discharge without complications. VAS 7 day in clinical office was 0. There were not recurrence or Bulkging in CT -Scan 1 month after the surgery. Discussion LIRA technique is a safe procedure with a low tension in the midline with good reults in terms of recurrence and bulging. LIRA-LESS concept allows a reduction in traumatic permanent fixation with good results in terms of pain and recurrence.