Initial Experience With an Intraoperative Fascial Stretching Device to Repair Complex Incisional Hernias

Abstract Aim Midline closure is a target of incisional hernia (IH) repair and poses a surgical challenge, especially in W3 IH. Therefore, measures such as surgical prehabilitation (Botulinum Toxin -BT- or progressive pneumoperitoneum -PN-) have been adopted. We present our initial results with a fascial traction (FT) device for treating large IH. Material and Methods Single-centre, observational, retrospective study (April 2022–December 2023), including patients treated with FT (transverse defect greater or equal to 15 cm). Epidemiological characteristics, comorbidity, prehabilitation, type of IH, bridging, surgical time, hospital stay, morbidity, mortality and recurrence were studied. Results Patients characteristics (N = 5) Male/Female 3/2 Age 57(43-63) Diabetes mellitus 2(40%) Arterial hypertension 4(80%) Body mass index 34,4 (30,7–41,5) CeDAR 32,6% (17-47) IH classification (EHS): 3 M2-3-4-5 (60%), 1 M2-3-4 (20%), 1 bilateral L1 (20%), all W3 (15–27 cm). 2 cases R0 (40%), 2 R1 (40%), 1 R2 (20%). All received preoperatively TB and 4 PP, mean insufflated volume 8150 cc (4000–14400).Surgery related parameters (N = 5)TechniqueRives-StoppaBilateral TAR3(60%)2(40%)MeshesPVDF2(40%)Biosynthetic +PPL3(60%)Primary fascial closure4(80%)Bridging(size)1(15 × 5 cm)Surgical time(minutes)278(210–330)IFSD use30 minutesHospital stay(days)12,8 (6–29)Related postoperative painLow2Medium2High1ComplicationsWound-related (N = 4,80%)Infection3 (60%)Seroma2 (40%)Haematoma2 (20%)General (N = 0)Mortality0Recurrences0 Conclusions FTD are useful to treat IH, but a rational use must be made through proper preselection of candidates (W3 defects wider than 15 cm), due to economic cost, increased surgical time and the possible complications they entail.