Intraoperative Fascial Traction for the Treatment of Large Hernias – Results of a Multicentre Study

Abstract Background The incidence of incisional hernias after laparotomy ranges between 5 and 20%. Closure of the defect and mesh reinforcement is therapeutic standard. Intraoperative fascial traction (IFT) is a new technique for hernia closure. Materials and Methods We analyse data of IFT from five hospitals between 12/2020 and 9/2023. In all cases the Fasciotens®Hernia System was applied. When fascia closure was not possible, transversus abdominis release (TAR) was performed. During follow-up all patients were examined according to a standardized protocol including ultrasound. Quality of life was assessed using the HerQLes questionnaire. Results A total of 96 patients were included in the study (HH-62, DA-11, SB-10, D-9, L-4). The age was 59.9 ± 14.1 years, 41% were female, BMI was 31.0 ± 7.3 kg/m², hernia width was 15.7 ± 5.1 cm. 88.5% underwent pretreatment with botulinum toxin (BTX). A TAR was performed in 28.1% cases. Bridging was necessary in 5.2%. Length of stay was 8.3 days. In the postoperative course, 39/96 (40.6%) patients experienced a complication: 20.8% seroma, 9.4% wound infection, 4.2% haematoma, 2.1% intestinal injury, 1.0% wound dehiscence, 3.1% pneumonia and 2.1% urinary tract infection. No patient died. The incidence of wound infections was higher in patients with additional TAR (11.1% vs. 8.7%). During the mean follow-up of 15.7 ± 12.6 months 2 hernias at the border of the mesh were recognized. The HerQLes summary score was 64.5. Conclusion This multicentre study shows a low incidence of wound infection and recurrences using IFT. The fascia closure rate is high when combining IFT with BTX pretreatment. Further randomised studies of IFT should follow to support these findings.