V-020 LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY: FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS

Abstract

Abstract We present the case of a 46-year-old-male patient, personal history: Chronic smoking; no previous abdominal surgeries. Height: 1,88 m. Weight: 100 Kg. BMI: 28. Clinical and ultrasound diagnosis of a painful and reducible ventral hernia M3 W1 (EHS Classification) associated with supraumbilical rectal diastasis (RD) of 4 cm transverse diameter T2 D2 H1 (EHS Classification). It is programmed for hernia and RD correction using de Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique. Access is laparoscopic at the left anterior axillary line level. Reduced umbilical hernia is identified and sickle cell ligament dissection is performed to identify and treat RD. The size of the umbilical defect and that of the supraumbilical RD are measured and, by means of a mathematical formula, the posterior aponeurosis of both rectal muscle is opened longitudinally parallel to both margins of the defect and the diastasis in order to suture the two flaps in the midline, allowing a tensión-free closure and also avoinding seroma formation and post-op bulging effect. We ended the procedure by placing an intraperitoneal mesh that we fixed covering the defect generated in the posterior aponeurosis. The LIRA technique could be considered an alternative to conventional defect closure (CD) or endoscopic component separation for midline defects smaller than 10 cm in transverse diameter. This is the first case of LIRA published in our latitude. It is a safe, effective and reproducible technique.