Long-term outcomes of a modified LIRA (laparoscopic intracorporeal rectus aponeuroplasty) technique for ventral hernia repair.

Abstract

<h4>Background</h4>Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique was developed to achieve tension-free closure for ventral hernia repair (LVHR). The aim is to report our long-term results with a modified LIRA technique evaluating its impact on postoperative pain, seroma, bulging and recurrence rates.<h4>Methods</h4>This single-center case series is a retrospective analysis of prospectively collected data. Seventy-four consecutive patients who underwent LVHR for M2-M4, W1-W2 defects, according to the European Hernia Society classification, with LIRA technique between 2017 and 2023 were included. LIRA was performed with a technical modification in which the posterior rectus sheath is incised approximately 1 cm from its medial border. This cohort is independent from our previously published. Patients were examined on postoperative days (POD) 1 and 7, and at 1, 3, and 12 months, for complications, pain (using the visual analogue scale, VAS), seroma (according to Morales-Conde classification), bulging, and recurrence, with a minimum follow-up of 12 months for all patients.<h4>Results</h4>Eleven patients (14.9%) had a primary hernia and sixty-three (85.1%) an incisional hernia, including two recurrences. The mean defect area was 38.3 ± 42.3 cm². Postoperative complications included four Clavien-Dindo I events and one Clavien-Dindo II event (6.8%). Mean VAS score was 5.1 ± 2.9 at POD 1, 1.5 ± 2.1 at POD 7, 0.3 ± 0.9 at one month, and 0 from the third month. Thirteen patients (17.6%) developed seroma (6.8% type I, 8.1% type II-a, 2.7% type II-b and 1.4% type III-a) all managed conservatively. At a mean follow-up of 66 ± 23.9 months, bulging and recurrences did not occur. Two hernias occurred at tacker sites (2.7%), treated surgically.<h4>Conclusions</h4>Modified LIRA technique is a safe, effective and durable for LVHR, with low complication, seroma, and recurrence rates. Pain control was favourable, with complete resolution by the third postoperative month. Further prospective comparative studies are required to confirm these findings.