Can large defects be closed laparoscopically without component separation?

The reconstruction of large incisional abdominal wall hernias presents a significant surgical challenge, particularly in patients with a history of repeated laparotomies, recurrent hernias, or unfavorable anatomical conditions. In recent years, techniques have been developed to achieve primary fascial closure without the need for extensive component separation. These procedures include the preoperative administration of botulinum toxin into the lateral abdominal wall muscles and intraoperative fascial traction. Concurrently, minimally invasive approaches are evolving; while their benefits for convalescence are evident, they encounter technical limitations regarding defect closure. The combination of fascial traction and a minimally invasive approach has not yet been described in the literature, and according to the manufacturer's data, only a handful of such operations have been performed worldwide. The authors present a case report of a patient with a large midline incisional hernia following polytrauma, who underwent a two-stage treatment comprising botulinum toxin application and subsequent minimally invasive reconstruction using the eTEP Rives-Stoppa technique combined with fascial traction using the fasciotens®Hernia system. The procedure led to a successful defect closure without the necessity of component separation, resulting in a highly satisfactory functional outcome. The discussion addresses the feasibility of incorporating this combination of techniques into the surgical portfolio for advanced abdominal wall defect management.