Intraoperative Fascial Traction* as an Alternative to Component Separation in Complex Incisional Hernia. Presentation of Our First 10 Cases

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)