Resultado de la aplicación preoperatoria de toxina botulínica A en el tratamiento de hernias incisionales gigantes

Abstract

IntroductionThe giant incisional hernias are characterized by complex ventral hernias, associated with such an important parietal loss that cannot be repaired with a simple suturing technique as in other hernias, they are associated with loss of domain, muscle atrophy and chronically decreased intra-abdominal volume.There are 2 surgical strategies for the treatment of giant parietal defects that are not suitable for the reaproximation of tissues under tension: one option is to bridge the defect, with grafts from the patient's native tissue or with synthetic products; the second option is to close the defect by preparing the aponeurosis with many preoperative techniques that promote progressive tissue expansion.The objective of this study is to evaluate the results of the transient muscular relaxation obtained by the application of preoperative botulinum toxin type A. MethodsA retrospective study was undertaken in 14 patients with giant incisional hernia between March 2012 and February 2014. The patients took a basal abdominal computed tomography, and were infiltrated with 50iu of botulinum toxin type A in each side of the abdominal wall; 4 weeks later they were submitted to surgery. ResultsWe found a reduction in the larger hernia diameter in 50% of the patients, without a significant reduction in the measures with a difference of 0.30cm (CI 95% -1.05 to 1.65, p=0.615), the total hernia area posterior to the infiltration had a reduction in 50% of the patients, with a difference of -34.21cm2 (CI 95% of -22.2 to 90.6, p=0.195). There have not been recurrences por 15 months. ConclusionsThe application of preoperative botulinum toxin type A for the management of complex ventral hernia is of great utility, but there is only one prospective study in which the benefit was statistically significant. Still, there are no randomized studies to establish the botulinum toxin type A doses, the application technique and the timing for surgery; these are features that we recommend to standardize with more studies to obtain better results.