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Updated: May 25, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
The concept of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique in complex abdominal hernias based
Salvador Morales-Conde1,2, Veronica Tamburi3, Antonio Curado Soriano1
1Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Sevilla, Spain.
Background:
The management of complex abdominal wall hernias remains a surgical challenge, particularly in selecting the most appropriate technique. This study reports our experience with the laparoscopic repair of complex hernias using the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique concept and its evolution as LIRA-like, LIRA with transabdominal preperitoneal extension (LIRA-TAPE), and the LIRA-Sugarbaker technique in case of parastomal hernia.
Methods:
A retrospective analysis of prospectively collected data was conducted from 2019 to 2025. Hernias were classified according to the European Hernia Society classification. Techniques were selected based on hernia location: LIRA for M1-M4 W3 defects, LIRA-like for L1-L4 W1-W3, LIRA-TAPE for M5 W1-W3, and the LIRA-Sugarbaker for parastomal hernias. Postoperative seroma was classified according to the Morales-Conde classification.
Results:
Nine patients underwent LIRA. Median defect width was 11 cm (range 10-15 cm) and median operative time was 100 min (range 60-173 min). Seromas occurred in 3 patients (33.3%) (two type I and one type II-a), all managed conservatively. Recurrences did not occur. In the LIRA-like group (11 patients), median defect width was 8 cm (range 1.5-14 cm), and median operative time was 60 min (range 25-110 min). Seromas occurred in 6 patients (54.5%) (one type I, two type II-a and 3 type II-b). One recurrence (9.1%) occurred due to central mesh failure. Seven patients with median defect width measured 10 cm (range 7-18 cm) underwent LIRA-TAPE. Median operative time was 70 min (range 45-110 min). One patient (14.3%) developed ileus and one (14.3%) seroma (type III-a), treated conservatively. Recurrences did not occur. Three patients, with median defect width of 9 cm (range 7-11 cm) underwent LIRA-Sugarbaker technique. Median operative time was 95 min (range 85-110 min). Across all groups, no intraoperative complications or conversions occurred.
Conclusions:
In this single-center retrospective study, the LIRA concept for the treatment of complex ventral hernias appears to be a safe and feasible approach, allowing tension-free defect closure with encouraging short-term outcomes.
