Lázaro da Silva’s Technique: Is It Still Current for Complex Incisional Hernias?

Resumen

In recent years, robotic surgery has been increasingly used in the treatment of complex hernias, particularly in specialized centers where this technology is widely available. However, classic open techniques continue to play an important role in the correction of these conditions, especially when extensive abdominal wall defects or significant loss of domain are present. Among these approaches stands the Bilateral Longitudinal Peritoneoaponeurotic Transposition, known as TRANSPALB, a technique developed by Alcino Lázaro da Silva around 1970 with the purpose of reconstructing the abdominal wall using autologous tissues while avoiding synthetic prostheses. The method is based on mobilization of the aponeurotic layers, allowing progressive medial advancement and closure of the defect with appropriate tension distribution. One of the main advantages of the technique is the possibility of repair even in potentially contaminated environments or in situations in which mesh implantation is not recommended. Nevertheless, the widespread use of synthetic meshes during the last decades contributed to reduced dissemination of TRANSPALB, because these materials often decrease operative time, simplify the procedure, and demonstrate good outcomes in several clinical series. Another relevant factor is the technical difficulty and the learning curve required for proper execution of the method. In a series of 88 patients operated between 2011 and February 2023, in hospitals of Santa Casa of Ouro Preto and the São Lucas complex, a recurrence rate of 12.3% in
elective cases and 17.4% in abdominal emergencies without severe hemodynamic instability was observed.