The outcome of pre-operative botulinum toxin in the treatment of large incisional hernias

Abstract

Large incisional hernias with loss of domain represents a challenge for the surgeon. Pre-operative tools such as progressive pneumoperitoneum or botulinum toxin type A have been reported as useful tools for effective and successful surgical procedure in patients with large incisional hernias. Both the mentioned procedures are complementary to hernia repair, using no-strain mesh techniques that support patients’ integral management. The objective of current investigation was to assess the potential of pre-operative botulinum toxin in the treatment of large incisional hernias. Thirteen patients with large incisional hernias were investigated and examined for different parameters including diameters of the abdominal cavity and hernia sac, volume of the contents of incisional hernia and volume of the abdominal cavity which were calculated from CT scan. The current investigation was carried for a duration of two years from December 2020 and January 2022. After thorough clinical examination patients were operated for ventral incisional hernia repair. Eleven patients underwent complete repair of abdominal wall; one patient underwent mesh bridging and one patient required onlay repair. Botulinum toxin was observed to be a safe technique, which has good patient tolerance and can constitute as an effective preoperative tool in the treatment of large incisional hernia. This technique was observed to be aidful in significantly reducing the hernia content into the abdominal cavity, which in turn is an important factor in the treatment of large incisional hernia.