Balthazar da Silveira Carlos A, Rasador Ana C D, Marcolin Patrícia, Kasakewitch João P G, Lima Diego L, Morales-Conde Salvador, Malcher Flavio
Bahiana School of Medicine and Public Health, Salvador, BA, Brazil.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
J Abdom Wall Surg. 2024 Oct 23;3:13497. doi: 10.3389/jaws.2024.13497. eCollection 2024.
Laparoscopic intracorporeal rectus aponeuroplasty (LIRA), emerged as a method that combines benefits from minimally invasive and abdominal wall reconstruction with defect closure, restoring the midline without tension by folding the posterior aponeurosis of both abdominal rectus muscles and using intraperitoneal mesh repair. We aimed to perform a systematic review of the existing evidence on LIRA results and potential applications.
A thorough search of Cochrane Central, Scopus, SciELO, LILACS, and PubMed/MEDLINE, focusing on studies that explored LIRA's possible applications and results was performed. Key outcomes evaluated included recurrence, seroma, hematoma, surgical site infection (SSI), and length of hospital stay. We included both analytic data and descriptive studies.
Out of 128 screened studies, three met the inclusion criteria and comprised 113 patients, of which 69 (61.1%) were operated using LIRA. Three studies comprised two case series of conventional and robotic LIRA repair, and one comparative study of LIRA versus intraperitoneal underlay mesh repair (IPUM plus). No surgical site infections were reported. Seroma rates ranged between 11.1% and 50%, while no bleeding or hematoma was noted. There were no patients presenting recurrence in a median follow-up ranging from 12 to 15 months, despite the comparative study reporting a 4.4% rate of bulging without clinical recurrence. The mean length of hospital stay ranged from 12 to 36 h. LIRA presented no differences in postoperative complications compared to the IPUM plus technique.
LIRA is linked to low recurrence and postoperative complications. It is a novel approach with potential applications in various types of primary and incisional ventral hernias.
腹腔镜体内腹直肌腱膜成形术（LIRA）是一种将微创和腹壁重建的优势与缺损闭合相结合的方法，通过折叠双侧腹直肌的后腱膜并使用腹膜内网状修复来无张力地恢复中线。我们旨在对有关LIRA结果和潜在应用的现有证据进行系统评价。
对Cochrane Central、Scopus、SciELO、LILACS和PubMed/MEDLINE进行了全面检索，重点关注探索LIRA可能应用和结果的研究。评估的主要结局包括复发、血清肿、血肿、手术部位感染（SSI）和住院时间。我们纳入了分析数据和描述性研究。
在128项筛选研究中，3项符合纳入标准，共纳入113例患者，其中69例（61.1%）接受了LIRA手术。3项研究包括两个传统和机器人LIRA修复的病例系列，以及一项LIRA与腹膜内补片修补术（IPUM plus）的对比研究。未报告手术部位感染。血清肿发生率在11.1%至50%之间，未发现出血或血肿。在12至15个月的中位随访期内，没有患者出现复发，尽管对比研究报告有4.4%的隆起率但无临床复发。平均住院时间为12至36小时。与IPUM plus技术相比，LIRA术后并发症无差异。
LIRA与低复发率和术后并发症相关。它是一种新方法，在各种类型的原发性和切口性腹疝中具有潜在应用价值。
