--- title: "Case Report: Lateral 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-lateral-hernia#top) [Skip to Content](https://www.fasciotens.com/case-report-lateral-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-lateral-hernia) - [Deutsch](https://www.fasciotens.com/de/case-report-lateral-hernia) ![Lateral hernia_Hero image](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia_Hero%20image.jpg?width=1024&height=1024&name=Lateral%20hernia_Hero%20image.jpg) IFT in lateral Hernias # Transmuscular placement of pulling sutures in a lateral hernia *Sana Hospital Benrath, Dusseldorf, Germany - December 2022* Drs. Hansjörg Meier and Sandrina Dascalescu successfully performed surgery on a 56-year-old patient (BMI: 24.2, ASA II, smoker) who, two years after undergoing a right-sided nephrectomy for renal cell carcinoma, developed an incisional hernia. ![Lateral hernia__0000_Standing](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0000_Standing.jpg?width=1024&height=1024&name=Lateral%20hernia__0000_Standing.jpg) ### Lateral bulging in the old surgical site The clinical examination revealed a defect measuring approximately 10 x 15 cm a bulging, which was prominent in the standing position. ![Lateral hernia__0001_Lying](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0001_Lying.jpg?width=1024&height=1024&name=Lateral%20hernia__0001_Lying.jpg) ### Flat belly in lying position However, in the lying position, the swelling was hardly visible. ![Lateral hernia__0002_CT Scan](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0002_CT%20Scan.jpg?width=1024&height=1024&name=Lateral%20hernia__0002_CT%20Scan.jpg) ### CT scan to confirm lateral hernia The preoperative CT scan confirmed the presence of an incisional hernia in the old surgical site with a defect width of 11.5 cm. ![Lateral hernia_0002_Botox](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia_0002_Botox.png?width=1024&height=1024&name=Lateral%20hernia_0002_Botox.png) ### Pre-treatment with Botox Four weeks before the operation, 150 units of Botox were injected into the oblique abdominal wall muscles on the right side. ![Lateral hernia__0004_Positioning](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0004_Positioning.jpg?width=1024&height=1024&name=Lateral%20hernia__0004_Positioning.jpg) ### Lateral positioning for surgery In preparation for the operation, the patient was positioned on his left side in a vacuum mattress for better exposure. ![Lateral hernia__0005_Width](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0005_Width.jpg?width=1024&height=1024&name=Lateral%20hernia__0005_Width.jpg) ### Intraoperative findings Intraoperatively, after preparation of the hernia sac, the defect measured 18 cm in the oblique craniocaudal and 8 cm in the lateral direction. ![Lateral hernia__0006_Hernia sac](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0006_Hernia%20sac.jpg?width=1024&height=1024&name=Lateral%20hernia__0006_Hernia%20sac.jpg) ### Preparing the preperitoneal space After opening the hernia sac, bowel loops were seen without any adhesions. The preperitoneal space was widely dissected in all directions from the edges of the hernia sac. ![Lateral hernia__0007_Mesh](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0007_Mesh.jpg?width=1024&height=1024&name=Lateral%20hernia__0007_Mesh.jpg) ### Preperitonial placement of the mesh A 35 x 30 cm PVDF mesh was now inserted into the large preperitoneal cavity. In addition, two 14mm redon drainage tubes are inserted. ![Lateral hernia__0008_Attaching system](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0008_Attaching%20system.jpg?width=1024&height=1024&name=Lateral%20hernia__0008_Attaching%20system.jpg) ### Transmuscular placement of the pulling sutures On each side of the defect, 6 USP 2 vicryl sutures were inserted transmuscularly passing through the external oblique muscle and the internal oblique muscle using a U-stich technique. These are then crossed and fixed in the clamps of the suture retention frame of the fasciotens®Hernia device under a pretraction of 14 Units (approx. 14 kg). ![Lateral hernia__0009_REtightening](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0009_REtightening.jpg?width=1024&height=1024&name=Lateral%20hernia__0009_REtightening.jpg) ### Increasing the traction forces gradually After every 2 minutes, the sutures were retightened manually and each individually. Next, the traction forces were gradually increased to 18 Units (approx. 18 kg) by turning the hand wheel of the traction controller. After 20 minutes, no further stretching of the muscles could be achieved and the defect edges were fully adapted. ![Lateral hernia__0010_Closure](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0010_Closure.jpg?width=1024&height=1024&name=Lateral%20hernia__0010_Closure.jpg) ### Closing the abdominal wall The internal oblique muscle and the aponeurosis of the external oblique muscle are closed using slowly absorbable PDS sutures. ![Lateral hernia__0011_No ICU](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0011_No%20ICU.jpg?width=1024&height=1024&name=Lateral%20hernia__0011_No%20ICU.jpg) ### No stay in ICU needed The postoperative course was without any complications. A stay in the intensive care unit was not necessary. The pain was successfully managed via an epidural catheter for 4 days and subsequently with Metamizole. The patient was discharged on the 5th postoperative day. ### Cosmetic results ![Lateral hernia__0015_Result_Post OP_1b](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0015_Result_Post%20OP_1b.jpg?width=1024&height=1024&name=Lateral%20hernia__0015_Result_Post%20OP_1b.jpg) ![Lateral hernia__0014_Result_Post OP_1a](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0014_Result_Post%20OP_1a.jpg?width=1024&height=1024&name=Lateral%20hernia__0014_Result_Post%20OP_1a.jpg) ![Lateral hernia__0012_Result_Post OP_2a](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0012_Result_Post%20OP_2a.jpg?width=1024&height=1024&name=Lateral%20hernia__0012_Result_Post%20OP_2a.jpg) ![Lateral hernia__0013_Result_Post OP_2b](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Lateral%20hernia__0013_Result_Post%20OP_2b.jpg?width=1024&height=1024&name=Lateral%20hernia__0013_Result_Post%20OP_2b.jpg) ![Cover_Hernia_DE_Sana Benrath_Sandrina Dascalescu](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2022_12_Lateral%20Hernia/Cover_Hernia_DE_Sana%20Benrath_Sandrina%20Dascalescu.jpg?width=3840&height=2160&name=Cover_Hernia_DE_Sana%20Benrath_Sandrina%20Dascalescu.jpg) × ### Sandrina Dascalescu successfully demonstrated the efficacy of IFT when applied laterally This case marked one of the pioneering uses of Intraoperative Fascial Traction in treating a lateral hernia. Sandrina was thrilled to witness the seamless applicability of this technique in such scenarios. 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. [![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://fasciotens.com?hsLang=en) - [About us](https://www.fasciotens.com/about-us) - [Contact](https://www.fasciotens.com/contact) - [Privacy](https://www.fasciotens.com/privacy) - [Terms & conditions](https://www.fasciotens.com/terms-conditions) - [Imprint](https://www.fasciotens.com/imprint) [tel:+4920199999630](tel:+4920199999630) [mailto:info@fasciotens.de](mailto:info@fasciotens.de)