Toxina botulínica A como adyuvante en hernia inguinoescrotal bilateral con pérdida de domicilio. Informe del primer caso y revisión bibliográfica

Abstract

IntroductionThe inguinoscrotal hernia with loss of domain is a rare condition; it is diagnosed when the hernia sac is found below the middle third of the thigh and containing more than 15 to 20% of the viscera. Although the application of botulinum toxin A was prior described for the reconstruction of abdominal wall ventral hernias, we use in a patient with inguinoscrotal hernia. No evidence was found in the literature about the application in these cases. We analyze and classify the different alternatives reported for these hernias. ObjectivesEvaluate the application of botulinum toxin A in inguinoscrotal hernia with loss of domain. MethodsApplication of botulinum toxin A in the abdominal wall muscles of a patient with bilateral inguinoscrotal hernia with loss of domain. Changes are analyzed in the muscle and abdominal cavity before and after injection in the basal and control tomography. Afterwards a hernioplasty with Stoppa technique is performed. ResultsThe effect of botulinum toxin A decreases the total lateral abdominal wall muscle thickness by 1cm and increases muscle length by 6cm. It increases the length in the rectus muscle by 1cm, increases 12.2% the maximum transverse diameter and consequently increases 25.9% the abdominal cavity volume. The surgical procedure was performed without complications. After 46 months there is no hernia recurrence. ConclusionsThe application of botulinum toxin A as an adjuvant, relaxes the abdominal wall muscles, facilitates performing the surgery and should be considered a new alternative for hernias with loss of domain.