Botulunim Toxin Type A Followed by TAR (Transversus Abdominal Release) with Abdominoplasty as the Best Combination for Big Hernia Repair

Abstract

Introduction: The current incidence of incisional hernia is up to 11%. Botulinum toxin type A shows atrophy in the extrafusal and intrafusal muscle fibers. With the addition of Muscle Paralysis and improving strength, it is possible to perform an effective posterior component separation. Objective: Describe an easy algorithm to treat complex abdominal wall reconstruction and improve the quality of adjacent tissues. Material and Methods: Fifty-nine patients were analyzed over 1 year in the General Surgery and Plastic and Reconstructive Surgery Service, patients with midline abdominal wall hernias, using the effective reconstruction algorithm, placing by ultrasound-guided botulinum toxin in the muscle transverse, 1 month later performing TAR, with Abdominoplasty for skin flap management, and comparing with the control group that did not apply botulinum toxin. Discussion: Botox is a neurotoxin derived from the bacterium Clostridium botulinum (botulinum toxin type A) that has been observed at the sensory level causing atrophy in the extrafusal and intrafusal muscle fibers. Repair of the abdominal wall after incisional hernias has been a great challenge with recurrence rates of 11%. Performing the release of the transverse muscle has a recurrence of 6%, as well as the compensation of skin flaps are ideal for proper management. Results: Within the observed analyzes, the results were divided into trans-surgical (99% of the patients closed the midline), immediate post-surgical (Pain, Seroma and Infection <1%) and late (with <3% recurrence) in the experimental group. Conclusions: Within the study, we will be able to analyze that lowering the recurrence rate <3% in patients properly protocolized, is translated as an adequate and totally reproducible method in our environment.