V-048 EXPANDING INDICATION OF LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) TO SUPRAPUBIC AREA: LIRA & TAPE

Abstract Aim LIRA-technique is a minimally invasive technique described to repair M2–M4 primary and incisional hernias. Defects below this area (M5 –Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps combining LIRA & TAPE for M2–M5 ventral hernias. Material & Methods 75-years-old-female patient with clinical examination and CT-scan showed a 9 cm width incisional hernia(W2), including the supraumbilical(M3), infraumbilical(M4) and suprapubic area(M5) with a total longitudinal length of 18 cm. Results The first step of the procedure is to open the peritoneum and posterior rectus sheath at 1–2 cm from the edge of the defect over the arcuate line. This flap allows following the dissection below arcuate line. At the suprapubic area, a bilateral peritoneal flap was done as indicated during the TAPE-repair until both Cooper ligaments are identified. Loop sutures were used for closing the defect, using the rectus muscle below the arcuate line, as well as the posterior rectus sheath above this line. A double-layer mesh is used in this case, being placed intraperitoneally. Conclusions The combination of LIRA & TAPE techniques provides an extension of the indication of concept associated to the LIRA for the repair of M5/W2 hernias, which could not be achieved using a conventional technique. Our initial experience with this technique, expanding the concept of LIRA to the suprapubic area, shows no recurrences and no postoperative morbidity.