What question did this study set out to answer?

To evaluate the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) techniques for managing complex abdominal hernias based on size and location.

May 25, 2026BMC Surgery0 citationsOpen Access

The concept of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique in complex abdominal hernias based on size and location

SMSalvador Morales-CondeHospital Universitario Virgen Macarena VTVeronica TamburiUniversity of Turin ASAntonio Curado SorianoHospital Universitario Virgen Macarena

Key Points

To evaluate the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) techniques for managing complex abdominal hernias based on size and location.
Retrospective analysis of prospectively collected data from 2019 to 2025.
Hernias classified according to European Hernia Society classification.
Surgical techniques utilized based on hernia characteristics.
9 patients underwent LIRA with a median defect width of 11 cm; operative time averaged 100 min, with seromas in 3 patients (33.3%).
11 patients in the LIRA-like group had a median defect width of 8 cm; 1 recurrence (9.1%) was observed due to central mesh failure.
In LIRA-TAPE (7 patients), median defect width was 10 cm with a 14.3% seroma rate but no recurrences.

Abstract

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. 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. 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. 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.

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