Preperitoneal LIRA: An alternative in primary midline hernia repair

The Laparoscopic Intracorporeal Rectus Aponeuroplsaty (LIRA technique) was developed to improve the results of laparoscopic ventral hernia repair, reducing tension in midline closure and promoting a more solid repair by facilitating healing, thus reducing pain, recurrence and postoperative bulging. One of its main drawbacks is the placement of an intraperitoneal mesh, which has been associated with potential medium and long-term complications (adhesion, occlusion or intestinal fistulas). In this video we show a modification of the LIRA technique in which we perform the same procedure in the preperitoneal space, not leaving the mesh exposed to intraabdominal viscera and avoiding its traumatic fixation, covering it at the end of the procedure with the peritoneum and, therefore, eliminating these possible complications. This technique could be a real alternative in primary midline hernias in which the peritoneum is intact (Fig. 1).

Fig. 1.

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