Lira Without Traumatic Fixations

Introduction Over the last decade we have made progress in laparoscopic mesh fixation, mainly to avoid post-operative pain. Post-operative pain can be significant, causing discomfort and delaying discharge. One of these advances has been the use of adhesives as a fixation system, there is currently a wide range available, from biological adhesives to cyanoacrylate derivatives. In our case, we present the absence of traumatic fixation systems in a LIRA type repair with glue. Case We present the case of a 49-year-old female patient who underwent laparoscopic appendectomy and presented with an incisional hernia over the umbilical trocar of 10 mm, with a defect of 4 cm in diameter in the transverse axis, multisacular, with associated diastasis. We used three trocars arranged in a fan between the left hypochondrium, left flank and left iliac fossa. After releasing the preperitoneal fat, the aponeurotic flap of the posterior aponeurosis of the rectum was prepared, turned and sutured in the midline. We placed the mesh and fixed it completely with adhesive (n-butyl-2-cyanoacrylate). The patient was discharged the day after surgery, and at 15 months follow up, there were no recurrence or complications. Discussion The evolution of fixation systems has brought us the existence of cyanoacrylates that allow precise fixation without leakage at the point of application, combined with an adequate mesh that allows a low postoperative pain. There are still gaps in the long-term results, it is therefore necessary to conduct studies on a larger number of patients to assess the long-term results.