LAUSR

Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present our preliminary results of this recent technique for midline hernias as an alternative to conventional CD emphasizing the evaluation of postoperative pain. A retrospective study was conducted from March 2021 to July 2022 to evaluate the elective procedure (LIRA) performed on patients with midline ventral hernias (3–4 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included postoperative pain and recurrence rate. Fourteen patients were included. Mean width of the defect was 3,5 cm. Average VAS (24 h) was 7, 2–3 (1 month), and 0 (6 month). Clinical seroma vas detected at first month in 50% (Clavien-Dindos-I). Recurrence rate was 14% at the expense of the first cases (Clavien-Dindos IIIb). Mean follow-up was 6 months. Despite the fact that this technique obtained a “no tension” effect that could be related to a lower rate of postoperative pain, we have detected an elevated early postoperative VAS which is probably due to the fixing system with tackers which counteracts the beneficial effect.