Laparoscopic application of intraoperative fascial traction (fasciotensⓇHernia) during loss of domain scrotal hernia repair: A European multicenter case series with technical details and preliminary results.

Laparoscopic intraoperative fascial traction was successfully applied in nine consecutive patients with S2 and S3 loss of domain scrotal hernias across eight European hospitals.

• Multicenter retrospective analysis conducted between November 2023 and August 2024
• Hospitals located in Italy, Germany, and Portugal
• All patients had S2 and S3 loss of domain scrotal hernia classification
• The median Tanaka index was 0.57

All patients underwent Lichtenstein repair as the primary surgical technique, with preperitoneal mesh added in some cases.

• All nine patients underwent Lichtenstein repair
• In two cases, a simultaneous preperitoneal mesh was added due to extensive inguinal defects
• Median operative time was 210 minutes
• Median IFT duration was 70 minutes with a traction force of 18 kg

Postoperative abdominal compartment syndrome did not occur in any of the nine patients.

• IAP was monitored in 55% of patients
• Median postoperative IAP value was 11.4 mmHg
• Median peak ventilation pressure before hernia reallocation was 16 mmHg and after was 19.5 mmHg
• Median differential in peak ventilation pressure was 3.5 mmHg (range 0–8)

Five of nine patients developed postoperative complications, all classified as Clavien-Dindo grade I and II.

• Five patients developed Clavien-Dindo grade I and II complications
• No grade III or higher complications were reported
• No recurrence was detected after a median follow-up of 19 months
• Median ICU monitoring duration was 1 day
• Median hospital stay was 9.5 days

Intraoperative fascial traction may reduce the need for preoperative progressive pneumoperitoneum in loss of domain hernia repair.

• IFT was described as a potential alternative or adjunct to preoperative pneumoperitoneum
• The technique was applied laparoscopically with a documented traction force of 18 kg
• IFT duration had a median of 70 minutes
• Authors suggest IFT may possibly prevent the development of postoperative abdominal compartment syndrome