Background: Incisional hernia is a late complication after abdominal surgery and large incisional hernias pose a challenge for general surgeons. Severe cases of giant hernias with loss of domain are referred to as complex hernias. Lateralisation and shrinkage of the vertical abdominal muscles leads to hernia progression and the hernia cannot be closed without tension. Since 2017 there has been a development of intra-abdominal wall traction devices. However, these devices come at great cost. We present two cases – elective and emergency of an alternative to providing abdominal wall traction with equipment relatively available at most hospitals. Case Presentation Intraoperative abdominal wall traction with the use of Omni-Tract table wall retractor to apply anterior and lateral retraction. 53yo female with a 15 x 15cm defect presents for a complex hernia repair. She is a smoker 10-15/day with a 30 pack year history and BMI of 18. Initially a retrorectus repair was performed however there was still a 6cm defect. Intraoperative tension was applied and both the posterior and anterior sheath was closed. Use of 1 Ethibond and horizontal mattress sutures, tension applied for 3x10 minute intervals. A 24yo male underwent a laparoscopic subtotal colectomy for Crohn’s complicated by anastomotic leak, anastomotic take down and ongoing pelvic sepsis and stump leak. Treated with laparostomy and repeated washouts. Underwent Botox on day 7 post-operative and intraoperative abdominal wall tension in order to close a 12cm defect. Onlay prolene mesh on fascia was used and the use of 1 nylon vertical mattress. Conclusion We present two cases of intraabdominal wall tension that were able to close large defects with minimal additional theatre time.