Infiltración de toxina botulínica en la preparación preoperatoria de las hernias con defectos de 10 cm (y hasta 15 cm)

Abstract

Abdominal wall defects represent a challenge for surgeons because of lateral muscle retraction and the difficulty of the reapproximation during refunctionalization of the abdominal wall. The use of botulinum toxin type A for muscle relaxation is a method that facilitates surgical reconstruction.Thirty six patients who had undergone giant incisional hernia repair were included in the study. A preoperative abdominal computed tomography scan was performed on all of them to identify the lateral abdominal wall muscles and determine the exact point where to infiltrate the Botulinum toxin type A. Four weeks later they underwent a computed tomography scan to control toxin response and they were scheduled for surgical reconstruction of the abdominal wall.In this series of patients with aponeurotic defects sized between 10 and 15, closure without tension was successful in 27 cases (75%), other perioperative techniques were required in 25% of the remaining patients (component separation and sac plication).The mesh was used in different levels: 39% IPOM, 36% Onlay, 13% with 2 layers of mesh (Sandwich-technique), 6% Inlay and 6% with Rives’ technique. In 5 patients restoration of intestinal continuity due to previous stoma was performed as a simultaneous procedure. There were no complications related to the infiltration of the toxin, and postoperative morbidity (9 cases) was directly related to the complexity of those hernias.We consider that the use of botulinum toxin type A in the abdominal wall is a useful tool for preparation for patients with 10-15 cm ventral hernias, since it allowed primary closure without tension in most (75%) of our cases.