AUTHOR=Niebuhr H. , Woeste G. , Winkler C. , Behle S. , Reinpold W. , Dag H. , Köckerling F. 
  
TITLE=Intraoperative Fascial Traction - From Concept to Comprehensive Application
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.16018
  
DOI=10.3389/jaws.2026.16018
  
ISSN=2813-2092
  
ABSTRACT=Intraoperative Fascial Traction (IFT) represents a promising alternative technique for complex abdominal wall reconstruction in large ventral hernias, particularly those exceeding 10 cm in width. Developed by Swiss and German surgeons and introduced clinically in 2021, IFT achieves fascial closure without extensive muscle component separation. Multiple studies demonstrate closure rates of 79%–96% for defects below 19 cm, though rates decline significantly for larger defects. Preoperative botulinum toxin A (BTA) administration and transversus abdominis muscle release (TAR) are often combined with IFT. The paper discusses the Hamburg algorithm 2.0 as it provides a structured treatment approach based on defect width, recommending IFT as a first-line intervention for defects up to 15 cm and incorporating additional component separation for larger hernias. Controlled fascial traction allows standardised treatment and can lead to higher fascial closure and lower recurrence rates.