V-039 EXPANDED INDICATION FOR LAPAROSCOPIC INTRACORPOREAL RECTUS MUSCLE APONEUROPLASTY (LIRA) IN PARASTOMAL HERNIA

Abstract

Abstract Aims Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique for the repair of incisional hernias from M2 to M4, but using the basic concepts of the technique, it allows an extended indication for other types of hernias such as suprapubic, lateral, or as in our case, the parastomal. The aim is to present step by step the larparoscopic aponeuroplasty technique as an alternative for parastomal hernia repair, as a modification of the original LIRA-technique. Material & Methods We present a 56-year-old patient with a history of abdominoperineal resection in 2012, who presented a symptomatic parastomal hernia. Clinical examination and computed tomography (CT) showed a partially reducible type I parastomal hernia, 8×11cm. Results We begin by releasing adhesions and reducing the hernial sac, always with control of the vascular axis, avoiding ischemic events. We opened the peritoneum and the transversus muscle 1–2 cm from the edge of the defect. We closed the defect using the transversus muscle as well as the posterior rectus sheath. We reduce the pneumoperitoneum to adapt the mesh and fix it using non-absorbable tackers and fibrin glue coating. Conclusions The LIRA technique guarantees a reconstruction of the midline, reinforcing this area without tension in ventral hernias. Based on this condition, we apply the concepts in a parastomal hernia, the original technique being equally reproducible, providing the advantages of laparoscopic surgery in terms of less pain. and morbidity, and betting on the minimization of tension compared to primary closure, as well as less appearance of seroma.