Laparoscopic Intracorporeal Rectus Aponeuroplasty (Lira) in a Post-Peritonectomy and Hipec Patient. How Far Can We Go?

Background Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) was first described in 2018. Since then, its application has grown, particularly in challenging scenarios, such as cases following Cytoreductive Surgery with Peritonectomy and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC). This video aims to demonstrate the application of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique in a complex midline ventral hernia case. Patient and Methods Video presentation demonstrating the step-by-step execution of LIRA technique. The video showcases the feasibility, safety, and potential advantages of this method in improving surgical outcomes. Results We present the case of a 66-year-old female patient with a history of multiple surgeries for ovarian cancer. In 2016, she underwent CRS + HIPEC. In 2017, she was reoperated through bilateral subcostal laparotomy due to tumor recurrence in the celiac trunk. Because of several supra and infraumbilical hernial defects, she underwent minimally invasive abdominal wall reconstruction using LIRA technique. During the postoperative period, the patient developed a septic condition and on the tenth postoperative day a exploratory laparotomy was performed, but no signs of infection were found. Conclusion This case not only highlights the advancements achieved in minimally invasive techniques but also demonstrates that LIRA enables tension-free midline restoration, providing a promising alternative to conventional component separation or endoscopic procedures.