Deutsch
Testimonials
Congenital malformations of the abdominal wall and rare acquired abdominal compartment syndromes in early childhood require special therapy of abdominal wall stretching. Various treatment methods have been developed for this purpose. However, these methods do not allow an objectifiable and controlled traction on the abdominal wall.
fasciotens®Pediatric is a method that allows a controlled traction to be applied to the abdominal wall. First results of the application of fasciotens®Pediatric for abdominal wall malformations in newborns are promising.
Currently, a Germany-wide application study is being conducted, for which further participating institutions are invited.
Not only is the use of fasciotens®Pediatric in pediatric surgery a promising tool for abdominal wall closure of complex congenital abdominal wall defects – more importantly, it has just been instrumental in decisively influencing the outcome of a little girl in the context of an individual healing trial.
After multiple abdominal compartment syndromes due to metastatic neuroblastoma with massive hepatomegaly, targeted pressure relief of the abdominal organs was life-decisive for the 3-month-old child: this made it possible to continue chemotherapy continuously despite persistent expansion of the metastatic liver. After weeks in the open abdomen with fasciotens, “tumor-free” was then celebrated at Christmas! This is only possible through innovative concepts, university flexibility and close cooperation with the industrial partners of fasciotens.
We have experience with thirty fascia traction procedures performed so far with the fasciotens device in large loss-of-domain hernias with widths up to 40 cm (W III +++): 28 hernias could be closed primarily without tension after 30 minutes of intraoperative traction with 12 kg.
In 2 cases with a width of 40 cm and 25 cm (in this case, however, with considerable scar bone formation), we were also able to achieve a stretch gain of approx. 10 cm in each case, but were then able to close the abdominal wall by means of additional transversus abdominis release (TAR) and use of a large sublay mesh as well as a bridging mesh.
Fascia traction with fasciotens presents itself to us as a simple procedure for the treatment of large loss-of-domain hernias and helps to avoid complicated and complicating component separations in some cases.
Abdomen apertum occurs especially after aortic rupture (incidence 10-20%). In this patient, pressure relief on the abdominal organs is essential and, as far as I know, the fasciotens system is the only system that can really guarantee this. It is a very new and effective procedure.
We have also used fasciotens on awake patients, with intermittent traction… the patient tolerated it well and it did not subjectively affect his respiratory function….
We were able to use the fasciotens system in a planned operation and a huge hernia with loss of domain. It was amazing to see how the abdominal wall distended within 40 minutes. We did not have to perform a lateral release and were able to achieve closure of the abdominal wall with the help of a sublay placed mesh.
In acute care surgery we have to face sometimes very challenging situations with hostile abdomens. Fascial retraction, visceral edema and loss of domain might become a nightmare also in experienced hands. A simple concept as vertical traction obtained with the use of Fasciotens helped me to close an abdomen that seemed to be a “mission impossible”. Surprisingly, with few tips and tricks provided by the company and colleagues that had previous experience with this new device, the management has been quite simple.
In my experience, the fasciotens system can be used quickly and easily even by the inexperienced. The material is of high quality and works reliably. The results I have achieved in a short time thanks to the system, both with open abdomens and with large abdominal wall hernias, have convinced me. Fasciotens is now an integral part of our surgical armamentarium!
It is amazing what the Fasciotens device can do. This applies to the closure of large abdominal wall hernias with “loss of domain” as well as to patients with open abdomens in intensive care. It succeeds in closing the abdomens without the use of surgical procedures such as “component separation ” or “TAR”. In patients with giant hernias, securing the result with a sublay mesh is crucial from my point of view. The long-term results for patients with open abdomen remain to be seen, as they cannot receive sublay mesh reinforcement. In some of these cases, an elective second operation with mesh is a conceivable option for lasting success.
We succeeded in directly closing a 25 x 22 cm hernia after 30 minutes of intraoperative traction. For augmentation of the abdominal wall, in the case of additional lateral hernias on both sides, in addition to mesh placement in the sublay position, a bds. TAR was performed to enlarge the mesh bed. The postoperative course was without complications and the patient left our hospital satisfied on the 6th postoperative day.
Recently we performed the first laparoscopic application of standardized fascial traction provided by fasciotens and supported by Dr. Gereon Lill for a recurrent umbilical, an epigastric hernia and a rectus diastasis between 6 and 7 cm from below the umbilicus to the xiphoid. We did a minimal-invasive stapler-assisted reconstruction of the midline, closing the anterior and posterior sheeth and augmenting the abdominal wall with a retromuscular 15 x 28 cm PVDF-based mesh which can be easily visualized and 3-dimensionally reconstructed by MRI. The traction was applied for 20 min, but leads to a complete adaption of the midline already after 5 min. The stapler could be applied much easier when compared with our experience in previous procedures without traction! I am convinced that this technique which is originally designed for closure of open abdomen situations and major abdominal wall defects will have a place in midline defects up to W2 and repaired by laparo-/endoscopic procedures with an retromuscular mesh augmentation as well as in all kinds of lap-IPOM plus procedures. In lap IPOM plus mass sutures are no more necessary.
Thanks a lot to Dr. Dietmar Eucker for developping the technique of fascial traction and to Gereon and his team of fasciotens to provide that sophisticated machine for easy use even in laparo-/endoscopic procedures!!!
After the numerous positive experiences from adult surgery, the pediatric system (fasciotens®Pediatric) is finally available. We have now used it 5 times for congenital abdominal wall defects: It is surprising how much fascia gain can be achieved with just one session of intraoperative traction. Even with prolonged use over several days, the extent of abdominal cavity enlargement is enormous.
Our field of application for fasciotens®Pediatric has so far been the targeted use in newborns with pronounced gastroschisis or with omphalocele per magna. Ultimately, this tool should also be taken up as an optimization for congenital large diaphragmatic hernias or fulminant necrotizing enterocolitis with impossible primary abdominal wall closure. Previously used fascia traction did not provide objectifiability of actual force application and presented technical challenges to nursing teams and medical colleagues in daily care.
fasciotens®Pediatric provides a standardized, controlled traction force that can be continuously monitored and adjusted to suit the patient, even after instruction by nursing staff.
This does not make pediatric surgical expertise any less important for this patient population. On the contrary, it offers us the possibility to provide our young patients with a sufficient midline closure of the abdominal wall in a shorter time – independent of the surgeon.
When an innovation is created with boundless euphoria, the simplicity of the active principle is celebrated together with the managing director at the operating table (on 24.12.) and everyone afterwards knows exactly what they have to do and enjoys implementing it, then the Fasciotens company has just solved another problem. Thank you for the product and the excellent support.
With fasciotens I was able to close a 16 cm wide hernia without further component separation. The patient complained of hardly any pain postoperatively and could be discharged after 7 days. This is an impressive result for such a large hernia.
In particular, the risk of a postoperative wound complication is significantly lower due to the much smaller wound area compared to the transversus abdominis release.
After this experience, I am absolutely convinced of the effectiveness and benefit of fasciotens in the treatment of complex abdominal wall hernias.
After Dietmar Eucker presented the method at the Hernia Days in Cologne in 2018, D. Eucker, O. Stern and I formed the AWEX (Abdominal wall expanding System) study group because of the simplicity and the promising effects. The results, including the long-term results, are really very good! After treating a patient with Fasciotens for the first time, I was immediately enthusiastic about the device. Fasciotens leads to a very high comparability of data from different centres due to the standardisation of the traction device and especially due to the precisely defined traction force that is possible for the first time with Fasciotens. Fasciotens thus raises intraoperative abdominal wall stretching to a new level.
A major advantage of the method is that it is possible to dispense with the dissection of the intact lateral abdominal wall and thus achieve a significant reduction in the wound cavity.
Also, parts of the dissection outside the hernial orifice can be performed according to minimally invasive principles. Thus, the undermining of the linea alba cranially and causally can be performed in a less-open sublay technique. In this way, the tissue can be additionally spared.
Fasciotens is a very promising new option for the treatment of large abdominal wall and incisional hernias.
In Emergency Surgery it is not uncommon to carry out repeated and prolonged open abdomen (OA) operations in order to control and eradicate complex intra-abdominal infections. These open operations involve inevitable fascial retractions making it difficult or impossible to close the abdominal wall except with the use of prostheses with additional risks of early or late infections.
The idea that vertical traction increases abdominal volume, reduces intra-abdominal pressure, stretches the fascial surface and facilitates the direct closure of OA is very fascinating.
In April 2020, we used fasciotens®Abdomen in a young patient with prolonged open abdomen due to multiple abscesses both central and bilateral, following severe necrotizing pancreatitis.
For the first time, in Italy, fasciotens Abdomen was used in a bilateral subcostal laparotomy with a loss of substance of 18 cm after 3 weeks of open abdomen and within 15 days we were able to perform a direct closure of the abdomen.
The fasciotens system, applied to the acute abdomen in peritonitis, eliminates the concern of not being able to close the abdominal wall after VAC therapy has been completed. Eventhough the skepticism about the ability to combine fasciotens & abdominal VAC was initially great, all concerns and difficulties were dispelled by the excellent support.
The result is impressive: tension-free abdominal wall closure with a 12 cm gap in the fascial edges before application of the system, mobilization of a patient at ward level within a week, who would certainly still be in bed for a long time without primary abdominal wall closure.
fasciotens is a good complement in the treatment of severe courses of abdomen apertum.
When I first heard about the technique, I found the biomechanical principle behind it ingenious and was almost annoyed that I hadn’t thought of it myself. I only had reservations about whether the fascia stretching would also last postoperatively. These concerns were immediately dispelled during the first application. A loss-of-domain hernia with a more or less destroyed abdominal wall after 6 previous operations and we managed to almost completely close a 23 cm defect. A year later it is still holding!
The system already convinced us when it was used for the first time. The promised gain in length was easily reproduced intraoperatively in a loss-of-domain hernia (W3+), and component separation was no longer necessary. This saves a costly and complication-prone procedure that additionally weakens the abdominal wall. Especially in cases of increased co-morbidity, this is a high benefit for the patient.
… without words …
