Preoperative botulinum A toxin as an adjunct for abdominal wall reconstruction: a single-center early experience at an Academic Center in New York.

Cosman Camilo Mandujano,Diego Laurentino Lima,Patricia Friedmann,Flavio Malcher,Analena Alcabes,Xavier Pereira

doi:10.1590/0100-6991e-20213152

Cosman Camilo Mandujano, Diego Laurentino Lima + Show 4 more

Open Access

https://doi.org/10.1590/0100-6991e-20213152

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Abstract

the botulinum toxin A (BTA) has been used to achieve a chemical component separation, and it has been used with favorable outcomes for the repair of complex ventral hernia (CVH) with and without loss of domain (LD). The aim of this study is to describe our early experience with the chemical component separation in the United Sates. a retrospective observational study of all patients who underwent ventral hernia repair for CVH with or without LD between July 2018 and June 2020. Preoperative BTA was injected in all patients via sonographic guidance bilaterally, between the lateral muscles to achieve chemical denervation before the operation. Patient demographics, anatomical location of the hernia, perioperative data and postoperative data are described. 36 patients underwent this technique before their hernia repair between July 2018 to June 2020. Median age was 62 years (range 30-87). Median preoperative defect size was 12cm (range 6-25) and median intraoperative defect size was 13cm (range 5-27). Median preoperative hernia sac volume (HSV) was 1338cc (128-14040), median preoperative abdominal cavity volume (ACV) was 8784cc (5197-18289) and median volume ration (HSV/ACV) was 14%. The median OR time for BTA administration was 45 minutes (range 28-495). Seroma was the most common postoperative complication in 8 of the patients (22%). Median follow up was 43 days (range 0-580). preoperative chemical component separation with BTA is a safe and effective adjunct to hernia repair in CVH repairs where a challenging midline fascial approximation is anticipated.

Highlights

The repair of a challenge complex ventral hernias to the general surgeon.(CVH) Large poses hernia defects, loss of domain (LD), multiple previous operative repairs, and associated patient comorbidities can result in increased morbidity and high recurrence rates
Preoperative chemo-denervation of the abdominal wall muscles with botulin toxin type A (BTA) allows for fascial approximation, often reducing the need for additional surgical myofascial release due to the thinning and lengthening of the abdominal wall musculature achieved with BTA
The increased compliance of the abdominal wall achieved with the use of BTA may reduce the potential risks of abdominal compartment syndrome, ventilatory restriction, and prolonged ileus among other described complications related to increased intrabdominal pressures4-6

Summary

Introduction

The repair of a challenge complex ventral hernias to the general surgeon. (CVH) Large poses hernia defects, loss of domain (LD), multiple previous operative repairs, and associated patient comorbidities can result in increased morbidity and high recurrence rates. One new adjunct option to help deal with this challenging patient population has been the use of botulin toxin type A (BTA). This neurotoxic agent blocks the release of acetylcholine from peripheral cholinergic nerve terminals inducing muscle paralysis. Preoperative chemo-denervation of the abdominal wall muscles with BTA allows for fascial approximation, often reducing the need for additional surgical myofascial release due to the thinning and lengthening of the abdominal wall musculature achieved with BTA. The increased compliance of the abdominal wall achieved with the use of BTA may reduce the potential risks of abdominal compartment syndrome, ventilatory restriction, and prolonged ileus among other described complications related to increased intrabdominal pressures

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