Gök Hakan
Hernia Istanbul, Comprehensive Hernia Center, Istanbul, Türkiye.
J Abdom Wall Surg. 2025 Mar 14;4:14283. doi: 10.3389/jaws.2025.14283. eCollection 2025.
The primary goal in incisional hernia repair is achieving primary fascial closure and reinforcing the area with a synthetic mesh. However, when Loss of Domain (LoD) is present, serious complications such as intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may arise. Various strategies have been employed to overcome these challenges and increase the reduced intra-abdominal volume, including preoperative botulinum toxin (BTA) injection, progressive pneumoperitoneum (PPP), various component separation techniques, and their combinations. Intraoperative fascial traction (IFT) has recently been added to this armamentarium. The two cases presented here aim to demonstrate the potential benefits of this innovative technique and offer a different perspective to surgeons dealing with such challenging cases.
The two patients presented here had previously undergone open umbilical hernia repair with mesh-one 17 years ago and the other 5 years ago-both of whom experienced recurrence and developed LoD over time. In both cases, IFT was successfully performed, resulting in an uneventful recovery.
The repair of incisional hernias accompanied by LoD presents significant challenges. In managing these cases, it is essential not only to optimise the patient preoperatively but also to employ interventions aimed at increasing intra-abdominal volume. In recent years, the intraoperative fascial traction (IFT) technique has emerged as a valuable tool in complex incisional hernia repairs. This technique not only facilitates primary fascial closure but also significantly increases intra-abdominal volume, potentially reducing the risks associated with intra-abdominal hypertension and compartment syndrome.
IFT offers promising advantages in the repair of incisional hernias with LoD, as it addresses the dual challenge of achieving primary fascial closure and restoring intra-abdominal volume. The two cases presented highlight the potential of this innovative technique in achieving successful outcomes. However, further research and larger studies are needed to fully establish its efficacy and long-term benefits in this challenging patient population.
切口疝修补的主要目标是实现筋膜的一期闭合并用合成补片加强该区域。然而，当出现腹腔容量减少（LoD）时，可能会出现诸如腹腔内高压（IAH）和腹腔间隔室综合征（ACS）等严重并发症。已经采用了各种策略来克服这些挑战并增加减少的腹腔容量，包括术前肉毒杆菌毒素（BTA）注射、渐进性气腹（PPP）、各种组织分离技术及其组合。术中筋膜牵引（IFT）最近也被加入到这一技术手段中。这里介绍的两个病例旨在展示这种创新技术的潜在益处，并为处理此类具有挑战性病例的外科医生提供不同的视角。
这里介绍的两名患者此前均接受过开放脐疝修补术并使用了补片，一名是在17年前，另一名是在5年前，两人均出现复发并随着时间推移出现了腹腔容量减少。在这两个病例中，均成功实施了术中筋膜牵引，恢复过程顺利。
伴有腹腔容量减少的切口疝修补面临重大挑战。在处理这些病例时，不仅要在术前优化患者状况，还要采用旨在增加腹腔容量的干预措施。近年来，术中筋膜牵引（IFT）技术已成为复杂切口疝修补中的一种有价值的工具。该技术不仅有助于筋膜的一期闭合，还能显著增加腹腔容量，有可能降低与腹腔内高压和间隔室综合征相关的风险。
术中筋膜牵引在伴有腹腔容量减少的切口疝修补中具有显著优势，因为它解决了实现筋膜一期闭合和恢复腹腔容量这一双重挑战。这里介绍的两个病例突出了这种创新技术取得成功结果的潜力。然而，需要进一步的研究和更大规模的研究来充分确定其在这一具有挑战性的患者群体中的疗效和长期益处。
