Introduction Abdominal wall reconstruction can present a major challenge in complex colorectal surgery. Fasciotens® is a novel device that provides progressive traction to the abdominal wall to aid fascial closure. Methods We present outcomes from five complex colorectal cases including operative and clinical photographs, using Fasciotens® for abdominal wall reconstruction. All patients received preoperative Botox® injections into the lateral abdominal musculature prior to surgery. All cases required laparotomy with extensive adhesiolysis and the Fasciotens® was applied intraoperatively for a minimum of 30 minutes. All cases were classified as clean-contaminated cases and required bowel resection with at least one anastomosis. Results Case 1: A 59-year-old male with an entero-cutaneous fistula and a midline ventral hernia; reconstruction with retrorectus Phasix® mesh. Case 2: A 68-year-old female with an end ileostomy and a midline ventral hernia; reconstruction with Parietene® mesh. Case 3: A 60-year-old female with an entero-atmospheric fistula and an associated midline defect; reconstruction with primary abdominal wall closure without mesh. Case 4: A 50-year-old male with an end colostomy and a midline ventral hernia; reconstruction with retrorectus Phasix® mesh. Case 5: A 66-year-old male with an entero-atmospheric fistula and an associated midline defect; reconstruction with bilateral transversus abdominis release and retromuscular Phasix® mesh. Conclusion Fasciotens® is an important operative adjunct for abdominal wall reconstruction in complex colorectal operations. Increasing international implementation with long-term follow-up will help define the optimal approach for abdominal wall reconstruction in these cases.