# 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

## TL;DR

This study explores a new laparoscopic technique for repairing complex scrotal hernias, showing it is safe and may prevent a dangerous abdominal condition.

## Contribution

The novel use of intraoperative fascial traction during laparoscopic repair of scrotal hernias with loss of domain is introduced and evaluated.

## Key findings

- IFT was safely applied in nine patients without causing abdominal compartment syndrome.
- IFT reduced the need for preoperative pneumoperitoneum and showed minimal postoperative complications.
- Median intra-abdominal pressure remained within safe limits, and no hernia recurrence was observed.

## Abstract

To describe the laparoscopic intraoperative fascial traction (IFT) in the repair of scrotal hernia with loss of domain (LoD), focusing on the prevention of abdominal compartment syndrome (ACS).

A multicenter retrospective analysis was conducted on nine consecutive patients with S2 and S3 LoD scrotal hernia, eligible for IFT, treated between November 2023 and August 2024 in eight European hospitals (Italy, Germany and Portugal). Technical details of laparoscopic IFT were documented. Postoperative intra-abdominal pressure (IAP), ventilatory parameters, complications, and recurrence were assessed.

The median Tanaka index was 0.57 and all patients underwent Lichtenstein repair; in two cases, a simultaneous preperitoneal mesh was added due to extensive inguinal defects. Median operative time was 210 min, with median IFT duration of 70 min and a traction force of 18 kg. Postoperative ACS did not occur. IAP was monitored in 55% of patients, with a median postoperative value of 11.4 mmHg. The median peak ventilation pressure before and after hernia reallocation was 16 and 19.5 mmHg respectively with a median differential of 3,5 mmHg (range 0–8). The median Intensive Care Unit (ICU) monitoring was 1 day, and the median hospital stay was 9.5 days. Five patients developed Clavien-Dindo grade I and II complications, with no recurrence detected after a median follow-up of 19 months.

The laparoscopic IFT is a safe and useful adjunct in the surgical repair of LoD scrotal hernias. IFT may reduce the need for preoperative pneumoperitoneum and possibly prevent the development of postoperative ACS.