V-039 EXPANDED INDICATION FOR LAPAROSCOPIC INTRACORPOREAL RECTUS MUSCLE APONEUROPLASTY (LIRA) IN PARASTOMAL HERNIA

Aims

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique for the repair of incisional hernias from M2 to M4, but using the basic concepts of the technique, it allows an extended indication for other types of hernias such as suprapubic, lateral, or as in our case, the parastomal.

The aim is to present step by step the larparoscopic aponeuroplasty technique as an alternative for parastomal hernia repair, as a modification of the original LIRA-technique.

Material & Methods

We present a 56-year-old patient with a history of abdominoperineal resection in 2012, who presented a symptomatic parastomal hernia. Clinical examination and computed tomography (CT) showed a partially reducible type I parastomal hernia, 8×11cm.

Results

We begin by releasing adhesions and reducing the hernial sac, always with control of the vascular axis, avoiding ischemic events. We opened the peritoneum and the transversus muscle 1–2 cm from the edge of the defect. We closed the defect using the transversus muscle as well as the posterior rectus sheath. We reduce the pneumoperitoneum to adapt the mesh and fix it using non-absorbable tackers and fibrin glue coating.

Conclusions

The LIRA technique guarantees a reconstruction of the midline, reinforcing this area without tension in ventral hernias. Based on this condition, we apply the concepts in a parastomal hernia, the original technique being equally reproducible, providing the advantages of laparoscopic surgery in terms of less pain. and morbidity, and betting on the minimization of tension compared to primary closure, as well as less appearance of seroma.

Liver Cirrhosis From Chronic Hypervitaminosis A Resulting in Liver Transplantation: A Case Report

Herein we report a case of liver dysfunction caused by consumption of vitamin A supplements leading to liver transplantation. The patient was a 48-year-old male with a medical history of congenital ichthyosiform erythroderma in treatment with vitamin A until 12 years of age, at which point he discontinued the supplements because he had developed ascites. Liver cirrhosis was diagnosed as secondary to hypervitaminosis A on the basis of histologic examination of liver biopsy and the absence of other potential causes of chronic liver disease. Despite interruption of administration of vitamin A, the patient continued to deteriorate over the years, with development of portal hypertension signs. His medical conditions were aggravated with the development of hepatic insufficiency manifested by refractory ascites, renal insufficiency, and severe encephalopathy and he underwent orthotopic liver transplantation, followed by disappearance of all signs of portal hypertension. This case highlights the need to take a careful history of consumption of vitamin A when evaluating a patient with liver failure.