Abstract
Background: Complex ventral hernia repair can be challenging despite the recent advances in surgical techniques. Here, we aimed to examine the effectiveness of preoperative combined use of botulinum toxin A (BTA) and preoperative progressive pneumoperitoneum (PPP) for surgical preparation of patients with complex ventral hernia.Methods: In this prospective, observational study, we included 22 patients with complex ventral hernia between January 2018 and May 2021. All patients were treated with BTA injections into the lateral abdominal muscles and PPP before hernia repair. The lengths of abdominal wall muscles, the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after BTA and PPP using abdominal CT scan. All Hernias were repaired using laparoscopic intra-peritoneal onlay mesh (IPOM) or laparoscopic-open-laparoscopic (LOL) techniques.Results: Imaging showed a significant increase in the mean lateral abdominal muscle length from 13.1 to 17.2 cm/side (p < 0.01). Before and after BTA and PPP, the mean VIH was 894 cc and 1209 cc (P < 0.01), and the mean VAC was 6,692 cc and 9,183 cc (P < 0.01). The VAC increased by 2,491 cc (P < 0.01) and was greater than the mean VIH before PPP. An average reduction of 0.9% of the VIH/VAC ratio after BTA and PPP was obtained (p > 0.05). All hernias were surgically reduced with mesh, hernia recurrence occurred in only two patients.Conclusions: The preoperative combined use of PPP and BTA increased the abdominal volume, lengthened the laterally retracted abdominal muscles, and facilitated laparoscopic closure of large complex ventral hernia.
Highlights
An incisional hernia is a common complication following abdominal surgery, with a 5-year incidence of 33.0% in patients undergoing open rectal cancer resection and 13.0% in laparoscopic resection [1]. a surgical mesh and component separation are widely used, high rates of hernia recurrence and morbidity remain considerable challenges
progressive pneumoperitoneum (PPP) can increase the volume of the abdominal cavity, facilitate the reintroduction of the hernia contents into the abdominal cavity, and improve respiratory adaptation; the possibility of postoperative abdominal compartment syndrome (ACS) is substantially reduced in patients with large incisional hernias [5, 7]
In the present prospective study, we aimed to examine the effectiveness of preoperative combined use of botulinum toxin A (BTA) injection and PPP in the management of complex ventral hernia
Summary
An incisional hernia is a common complication following abdominal surgery, with a 5-year incidence of 33.0% in patients undergoing open rectal cancer resection and 13.0% in laparoscopic resection [1]. a surgical mesh and component separation are widely used, high rates of hernia recurrence and morbidity remain considerable challenges. Chronic contractions of the abdominal muscles reduce the volume of the abdominal cavity and increase the difficulty of performing fascial closure, resulting in an increased risk of postoperative morbidities such as insufficient respiration and abdominal compartment syndrome (ACS) or failed hernia repair [5]. In these patients, adequate preparation prior to surgery is vital. We aimed to examine the effectiveness of preoperative combined use of botulinum toxin A (BTA) and preoperative progressive pneumoperitoneum (PPP) for surgical preparation of patients with complex ventral hernia
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