--- title: "Case Report: 25 cm incisional hernia" description: Do you want to see how fasciotens is applied in a surgery? Read the case report for a detailed step-by-step and hear the surgeon's opinion --- [Go Back Up](https://www.fasciotens.com/case-report-25-cm-incisional-hernia#top) [Skip to Content](https://www.fasciotens.com/case-report-25-cm-incisional-hernia#body) [![fasciotens home](https://www.fasciotens.com/hs-fs/hubfs/Logos/fasciotens_logo_aws_2020.png?width=200&height=52&name=fasciotens_logo_aws_2020.png "fasciotens home")](https://www.fasciotens.com?hsLang=en) Toggle Menu - [Open Abdomen](https://www.fasciotens.com/abdomen) Toggle children for Open Abdomen Main Menu (Press to Return) \> Open Abdomen - [Discover more](https://www.fasciotens.com/abdomen) - [Publications & Case Reports](https://www.fasciotens.com/case-reports-abdomen) - [E-learning courses](https://academy.fasciotens.com/pages/abdomen) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-abdomen) - [Complex Hernias](https://www.fasciotens.com/hernia) Toggle children for Complex Hernias Main Menu (Press to Return) \> Complex Hernias - [Discover more](https://www.fasciotens.com/hernia) - [Publications & Case Reports](https://www.fasciotens.com/case-reports-hernia) - [E-learning courses](https://academy.fasciotens.com/collections/hernia) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-hernia) - [Congenital Defects](https://www.fasciotens.com/pediatric) Toggle children for Congenital Defects Main Menu (Press to Return) \> Congenital Defects - [Discover more](https://www.fasciotens.com/pediatric) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-pediatric) - [Congresses & Workshops](https://www.fasciotens.com/congresses-workshops) - Services Toggle children for Services Main Menu (Press to Return) \> Services - [E-Learning](https://academy.fasciotens.com) - [Case Discussion](https://www.fasciotens.com/case-discussion) - [Product Feedback & Complaints](https://www.fasciotens.com/product-feedback) - [Downloads](https://www.fasciotens.com/downloads) - [Newsletter](https://www.fasciotens.com/newsletter) - [About us](https://www.fasciotens.com/about-us) - [Local Distribution Partners](https://www.fasciotens.com/contact#distributor) - [Contact](https://www.fasciotens.com/contact) - - [English](https://www.fasciotens.com/case-report-25-cm-incisional-hernia) - [Deutsch](https://www.fasciotens.com/de/case-report-25-cm-incisional-hernia) ![25 cm Giant Hernia\_NL\_\_0003\_09\_Full gain in fascia after only 15 min](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0003_09_Full%20gain%20in%20fascia%20after%20only%2015%20min.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0003_09_Full%20gain%20in%20fascia%20after%20only%2015%20min.jpg) Midline closure after only 25 minutes # 25 cm recurrence of a ventral incisional hernia *Slingeland Hospital, Doetinchem, Netherlands - October 2023* Susan Lemson and Bastiaan Wiering treated this patient with a giant ventral abdominal wall hernia. The patient already went through multiple procedures over a timeframe of 10+ years before coming to the hernia specialists at Slingleland. ![CT scan](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/CT%20scan.jpg?width=1024&height=1024&name=CT%20scan.jpg) ### CT scan Preoperative CT shows the hernia to have a laterolateral diameter of 25 cm. ![25 cm Giant Hernia\_NL\_\_0011\_01\_Pre-treatment with Botox](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0011_01_Pre-treatment%20with%20Botox.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0011_01_Pre-treatment%20with%20Botox.jpg) ### Pre-treatment with botulinum toxin (BTA) The patient received BTA injections 4.5 weeks prior to the hernia repairs. The result was as desired as the abdominal wall was floppy and relaxed. ![25 cm Giant Hernia\_NL\_\_0010\_02\_Full relaxation during anaesthesia](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0010_02_Full%20relaxation%20during%20anaesthesia.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0010_02_Full%20relaxation%20during%20anaesthesia.jpg) ### Full relaxation during anaesthesia The patient was under general anaesthesia with relaxant on a drip (perfusor). Full relaxation during Intraoperative Fascial Traction (IFT) is an important step to achieve the greatest possible stretching of the abdominal wall during the treatment. ![25 cm Giant Hernia\_NL\_\_0009\_03\_Releasing adhesions](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0009_03_Releasing%20adhesions.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0009_03_Releasing%20adhesions.jpg) ### Releasing adhesions The patient had severe adhesions due to multiple previous operations. A part of the hernia sack was preserved to bridge the posterior rectus sheet and to cover the abdominal cavity. ![25 cm Giant Hernia\_NL\_\_0008\_04\_Attaching the sutures to the fascia](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0008_04_Attaching%20the%20sutures%20to%20the%20fascia.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0008_04_Attaching%20the%20sutures%20to%20the%20fascia.jpg) ### Attaching the sutures to the fascia The sutures (multifilament, braided, uncoated, USP 2) are stitched as U-sutures to exposed anterior sheet of the rectus sheath with approx. 2 cm distance to the fascial edge. 6 sutures are used per side. The team took care to attach the sutures evenly along the fascia. ![25 cm Giant Hernia\_NL\_\_0007\_05\_Setting up fasciotens®Hernia](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0007_05_Setting%20up%20fasciotens%C2%AEHernia.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0007_05_Setting%20up%20fasciotens%C2%AEHernia.jpg) ### Setting up fasciotens®Hernia Assembling the device took the surgeons only 3 minutes. It comes with the IFU, a Quick Guide and video explanation. ![25 cm Giant Hernia\_NL\_\_0006\_06\_Attaching the system](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0006_06_Attaching%20the%20system.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0006_06_Attaching%20the%20system.jpg) ### Connecting the sutures Bastiaan brought the pre-tension to 14 units by pressing the traction controller down, while Susan attached the sutures to the retention frame. To keep the frame in balance she started with the corner sutures. ![25 cm Giant Hernia\_NL\_\_0005\_07\_Device fully set up](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0005_07_Device%20fully%20set%20up.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0005_07_Device%20fully%20set%20up.jpg) ### Device fully set up Only after all 12 sutures were secured, Bastiaan carefully released the pre-tension. The device now applies the standardized traction, which was set to 14 units in this case. ![25 cm Giant Hernia\_NL\_\_0004\_08\_Re-tightening the sutures](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0004_08_Re-tightening%20the%20sutures.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0004_08_Re-tightening%20the%20sutures.jpg) ### Re-tightening the sutures Susan and Bastiaan checked each individual suture every 2 minutes and pulled them tight again if necessary. Over time some parts of the abdominal wall/fascia may stretch more quickly than others. ![25 cm Giant Hernia\_NL\_\_0003\_09\_Full gain in fascia after only 15 min](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0003_09_Full%20gain%20in%20fascia%20after%20only%2015%20min.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0003_09_Full%20gain%20in%20fascia%20after%20only%2015%20min.jpg) ### Fascial edges back in midline position after only 15 min Due to the pre-treatment with BTA, the huge defect could have been closed after 15 minutes already. However, Susan and Bastiaan waited another 10 minutes to make sure that the fascia did not retract again during the mesh application. From our experience, in most cases the device can be removed after 30 minutes. ![25 cm Giant Hernia\_NL\_\_0002\_10\_Disassembling the device](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0002_10_Disassembling%20the%20device.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0002_10_Disassembling%20the%20device.jpg) ### Disassembling the device Bastiaan held the retention frame tightly while Susan released it. It is very important to follow this procedure as the frame will otherwise crash on the patient with full strength when released.  ![25 cm Giant Hernia\_NL\_\_0001\_11\_Inserting the mesh](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0001_11_Inserting%20the%20mesh.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0001_11_Inserting%20the%20mesh.jpg) ### Inserting the mesh The surgeons applied a polypropylene mesh in sublay position (retrorectus) following standard of care before closing the anterior rectus sheets. ![25 cm Giant Hernia\_NL\_\_0000\_12\_Midline closure](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_10_NL_25cm/25%20cm%20Giant%20Hernia_NL__0000_12_Midline%20closure.jpg?width=1024&height=1024&name=25%20cm%20Giant%20Hernia_NL__0000_12_Midline%20closure.jpg) ### Midline closure The anterior rectus sheets could be closed tension-free over the full length using a running suture (small steps, small bites). The surgeons used the sutures which connected the fascia with the Hernia device to pull the fascial edges towards each other to allow easier placement of the stitches. ![Cover\_Hernia\_NL\_Slingeland\_Susan Lemson](https://www.fasciotens.com/hs-fs/hubfs/Website%20Images/Cover_Hernia_NL_Slingeland_Susan%20Lemson.jpg?width=3840&height=2160&name=Cover_Hernia_NL_Slingeland_Susan%20Lemson.jpg) × ![](https://fast.wistia.com/embed/medias/3ks1t1yu8a/swatch) ### Susan Lemson was pleased with the successful treatment The leading surgeon Susan said that her first application of the fasciotens device exceeded her expectations as the midline could be restored after 25 minutes already - despite the huge defect of 25 cm / 8 cm under tension Start with fasciotens yourself ### Do you want to use fasciotens®Hernia during your next complex hernia surgery? Fill out the form and we will get in touch asap. 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