Fascial Traction as an Alternative to Posterior Component Separation in Patients With History of Peritoneal Surgery – A Case Report

Abstract Aim The aim of this communication is to present an alternative to posterior component separation for midline incisional hernia repair in patients with a history of peritoneal surgery. Material and Methods We present the case of a 62-year-old female patient with a history of stage IV rectal cancer who underwent ultra-low anterior resection, hysterectomy and resection of peritoneal implants. Subsequently the patient presented peritoneal progression, so she underwent peritonectomy with HIPEC. She came to our office presenting a M3-M5W2 eventration with a 10 cm defect, very symptomatic. Given the history of peritonectomy, the performance of a Transversus Abdominis Release (TAR) was discarded, opting for repair using a fascial traction device and the performance of a Rives-Stoppa technique. To facilitate traction, botulinum toxin was injected into the abdominal muscles. Results A Rives-Stoppa technique was performed with placement of a retromuscular polypropylene mesh. The defect was closed by means of a fascial traction device, applying 14–16 kg of force for 25 min. The anterior fascia was closed without bridging nor tension. The patient presented no complications in the immediate postoperative period and was discharged on the 2nd postoperative day. At 11 months the patient presents good general condition, with a continent abdomen and no signs of recurrence. Conclusions Peritoneal surgery is an increasingly used therapy in patients with late-stage cancers. These procedures may preclude the performance of techniques involving posterior component separation. The use of fascial traction devices is a viable alternative for abdominal wall repair in patients with a history of peritonectomy.