Intraoperative Fascial Traction for Treatment of W2 and W3 Ventral Hernias

Abstract Background Component separation techniques are increasingly employed in abdominal wall reconstruction surgery. The use of adjuvant techniques, such as intraoperative vertical dynamic fascial traction, enhances the compliance of the abdominal wall. This facilitates closure of the abdominal wall using less disruptive techniques without compromising effective treatment. Our aim is to retrospective review our results regarding the effectiveness and complication rate of intraoperative fascial traction for the treatment of complex ventral hernias. Method Conducted a retrospective analysis of 10 patients who underwent surgery using intraoperative fascial traction for W2 and W3 ventral hernias. Results Preoperatively, fascial distances measured ranged from 55 cm to 145 cm, with the majority of patients (70%) having a fascial distance greater than 10 cm. Most patients received other adjuvant treatments (nine cases with botulinum toxin injection and one with pre-operative progressive pneumoperitoneum). Posterior component techniques were employed in 40% of patients (half with W2 hernias and the other half with W3 hernias). The complication rate was 10%, with one case of hemorrhage requiring percutaneous embolization. During the average 6-month follow-up period (ranging from 1 to 17 months), one recurrence was observed. Conclusion Intraoperative fascial traction is a feasible and safe adjuvant technique for abdominal wall reconstruction. The use of adjuvants in complex abdominal wall hernia surgery may, in some patients, downstage the hernia, thereby avoiding the need for component separation techniques. This approach enables tension-free closure of the abdominal wall in a less invasive manner.