The use of botulinum toxin in hernia surgery: results of a survey in certified hernia centers

Abstract

Botulinum toxin application into the abdominal wall prior to major hernia repair can reduce the complexity of surgery and has been increasingly used in recent years, even if it is an off-label use. To what extent is botulinum toxin used in hernia surgery in German-speaking countries and what is the current evidence in the literature? In avoluntary online survey of German Society for General and Visceral Surgery (DGAV)-certified competence centers and reference centers for hernia surgery, aspects of botulinum toxin application were surveyed and the results analyzed. A total of 57centers took part in the survey, of which 27(47%) use botulinum toxin. The main reasons for not using it were lack of experience and reimbursement. Of the centers 85% have treated less than 50patients with botulinum toxin. The main indications were midline hernias (M2-4 according to the EHS classification) with ahernia gap > 10 cm (W3according to EHS classification) and loss of domain situations. The application was predominantly ultrasound-guided by designated hernia surgeons with 100-200 Allergan or 500 Speywood units 4-6weeks preoperatively and without complications related to the botulinum toxin application. Botulinum toxin injections in hernia surgery appear to be safe and effective. Ultrasound-guided preoperative bilateral administration is supported by the available data. Specific course and information formats should be offered by the hernia surgery institutions.