Abstract No. 523 Pre-operative Botox injection for ventral hernia repair: early experience at a single institution

Abstract

Ventral wall hernias are a common pathology occurring in 10% of open abdominal operations. Surgical management of hernias can be complex due to chronic muscle contraction resulting in recurrence and significant morbidity. Botulism Toxin A (BTA) has been described as a preoperative therapy utilized to reduce muscle contraction and increase intrabdominal volume. Interventional radiologists may increase procedural accuracy while reducing complications by utilizing ultrasound (US) guidance; however, corresponding literature and data are sparse. The present study describes the efficacy and safety of pre-operative US-guided BTA injection in patients undergoing ventral abdominal wall hernia repair at a single institution. Eight patients underwent BTA injection from 2018 to 2020. Injections were performed via ultrasound guidance targeting the external oblique, internal oblique, and transversus abdominis muscles at three locations along the right and left lateral abdominal wall. Retrospective chart review was performed documenting date of birth, sex, preoperative hernia size by computed tomography (CT) evaluation, postoperative hernia size by CT evaluation, post-operative clinical assessment of hernia repair, number of injections, units of Botox, complications, use of mesh, date of repair, and technical success. Technical success was considered to be the ability to inject the BTA in the target muscles. The cohort consisted of 25% (2/8) women and 75% (6/8) men with an average age of 43.3 ± 8.1 years. The maximal pretreatment diameter of the hernia defect prior to surgery was 14.7 ± 4.6 cm. The technical success was 100% (8/8). The patients each had a total of 18 injections and 7/8 (87.5%) had 300 units of BTA while 1/8 (12.5%) had 240 units of BTA injected. None of the patients suffered complications from the injections. The patients underwent hernia repair at an average of 34.7 ± 4 days following BTA injection. Twenty percent (1/5) of patients did not require mesh insertion. Pre-operative US-guided BTA injection is a safe procedure that can aid in ventral abdominal hernia repair via induction of flaccid paralysis.