INTRAOPERATIVE FASCIAL TRACTION* AS AN ALTERNATIVE TO COMPONENT SEPARATION IN COMPLEX INCISIONAL HERNIA. PRESENTATION OF OUR FIRST 10 CASES

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Abstract Objective We aim to present the outcomes of our initial 10 cases involving complex incisional hernias (W3 according to the EHS classification) treated with intraoperative fascial traction*. We will delineate patient characteristics, wall defect sizes, preoperative application of botulinum toxin (BT) or progressive pneumoperitoneum (PN), closure technique, and evolution during follow-up. Material and Methods From February 2022 we have used intraoperative fascial traction* in 10 cases. Half of the patients were male, with an average age of 59.5 years. In all cases, the defect width was ≥10 cm (average 13.3 cm). Two patients presented loss of domain (Tanaka index >20%). BT was used as an adjuvant in 7 cases, and PN was utilized in 1 case (10%). Results Primary closure without the need for component separation (CS) was achieved in all cases. Bridging (5 × 2 cm) was necessary in 2 cases to prevent excessive tension. Average hospital stay was 4.8 days, with only one case of Clavien-Dindo grade 3a complication (cutaneous dehiscence treated with vacuum therapy). After an average follow-up of 10.7 months (0.4–22.4), no clinical recurrence was detected. Conclusions In our experience, intraoperative fascial traction* proves to be an effective and safe alternative to CS for treating W3 ventral hernias, exhibiting a lower complication rate and a minimal occurrence of short-to-medium-term postoperative complications and recurrences. (* = Fasciotens® Hernia® device)

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