LAPAROSCOPIC REPAIR OF UMBILICAL HERNIA AND DIASTASIS RECTI BY LIRA TECHNIQUE

Abstract

Diastasis rectus abdominis is produced by an anormal separation of the rectus abdominis with s widening of the Linea alba, producing a deformity of the abdominal Wall when the abdomen is contracted. It can be symptomatic provoking pain or discomfort in the abdomen, musculoskeletal or urogenital problems and a negative corporal image with consequences in the quality of life. The most frequent presentations are in obese males and in women after pregnancy. The pathological diastasis recti exists with the widening of the rectus abdominis just over the umbilicus is superior to 2 centimeters. Depending on the distance, it can be more or less serious (and more or less probable the resolution by conservative treatments). The first treatment is physical therapy. When it is associated to hernias of the linea alba it is recommended surgical treatment including hernia repair and diastasis repair. The presence of diastasis recti it not only causes of symptoms but increases the possibility of appearing mor hernia defects. The surgical approach depends on the characteristic of the patients. If the patient needs an abdominoplasty, na open approach with dermolipectomy is performed. If there is no need for abdominoplasty, it will be better to perform a minimal invasive approach. Minimally invasive procedures have fewer wound complications, and therefore, decrease the morbidity of these surgeries. Minimally invasive approach can be made by several techniques: subcutaneous (SCOLA), retromuscular (e-TEP) or intraperitoenal (IPOM, LIRA). The advantage of the LIRA technique is that it can be made an approximation of the fascia, with repair of the hernia ring and the middle line, without opening the linea alba. In the video we present the surgical technique.