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Long-term results of botulinum toxin type A in complex abdominal wall repair and review of the literature

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Abstract

Administration of botulinum toxin (BTX) is being used in cases of complex ventral hernia for the reconstruction of the linea alba and closure of the abdominal wall. However, there are no published results regarding the long-term effects of BTX and its implication in hernia recurrence. Our purpose is to evaluate the outcomes in hernia recurrence of the administration of BTX in complex ventral hernia repair. 36 patients underwent elective surgery for complex ventral hernia and were evaluated retrospectively. The study included patients with a transverse hernia defect ≥ 100 mm and loss of domain hernias, receiving BTX injections 6 weeks prior to elective surgery. Global results and long-term recurrence were analysed. There were no complications related to BTX administration. The mean transverse hernia defect was 139.44 ± 50.98 mm, the mean abdominal cavity volume (ACV) was 10.19 ± 3.33 dm3, the mean hernia sac volume (HSV) was 1.93 ± 1.79 dm3, presenting a mean volume ratio (VR) of 20.71 ± 19.76%. Primary closure was achieved in 28 patients (77.8%), 21 of whom (75%) needed an anterior component separation technique. Recurrence rate was 11.4% at 2-years follow-up. BTX administration is a safe and feasible method for abdominal wall expansion prior to complex incisional hernia repair, achieving high rates of primary closure. Long-term follow-up shows good results in terms of recurrence in these patients.

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References

  1. Alam NN, Narang SK, Pathak S, Daniels IR, Smart NJ (2016) Methods of abdominal wall expansion for repair of incisional herniae: a systematic review. Hernia 20(2):191–199

    Article  CAS  Google Scholar 

  2. Elstner KE, Jacombs AS, Read JW, Rodriguez O, Edye M, Cosman PH, Dardano AN, Zea A, Boesel T, Mikami DJ, Craft C, Ibrahim N (2016) Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using botulinum toxin A. Hernia 20(2):209–219

    Article  CAS  Google Scholar 

  3. Muysoms FE, Miserez M, Berrevoet F, Campanelli F, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414

    Article  CAS  Google Scholar 

  4. Passot G, Villeneuve L, Sabbagh C et al (2016) Definition of giant ventral hernias: development of standardization through a practice survey. Int J Surg 28:136–140

    Article  Google Scholar 

  5. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cucurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Jänes A, Jeekel K, López-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanskii MS, Venclauskas L, Berrevoet F (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24

    Article  CAS  Google Scholar 

  6. Heger P, Pianka F, Diener MK, Mihaljevic AL (2016) Current standards of abdominal wall closure techniques: conventional suture techniques. Chirurg 87(9):737–743

    Article  CAS  Google Scholar 

  7. Cakmak M, Caglayan F, Somuncu S, Leventoglu A, Ulusoy S, Akman H, Kaya M (2006) Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study. J Pediatr Surg 41(4):821–825

    Article  Google Scholar 

  8. Chavez-Tostado KV, Cardenas-Lailson LE, Pérez-Trigos H (2014) Resultado de la aplicación preoperatoria de toxina botulínica A en el tratamiento de hernias incisionales gigantes. Rev Hispanoam Hernia 2:145–151

    Article  Google Scholar 

  9. Ramirez OM, Ruas E, Dellon AL (1990) Components separation method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526

    Article  CAS  Google Scholar 

  10. Heller L, McNichols CH, Ramirez OM (2012) Component separations. Semin Plast Surg 26:25–28

    Article  Google Scholar 

  11. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716

    Article  Google Scholar 

  12. Cavalli M, Bruni PG, Lombardo F, Morlacchi A, Andretto Amodeo C, Campanelli G (2019) Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy. Hernia. https://doi.org/10.1007/s10029-019-02030-7

    Article  PubMed  Google Scholar 

  13. Weissler JM, Lanni MA, Tecce MG, Carney MJ, Shubinets V, Fischer JP (2017) Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia. J Plast Surg Hand Surg 51(5):366–374

    Article  Google Scholar 

  14. Tanaka EY, Yoo JH, Rodrigues AJ Jr, Utiyama EM, Birolini D, Rasslan S (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14(1):63–69

    Article  CAS  Google Scholar 

  15. Zielinski MD, Goussous N, Schiller HJ, Jenkins D (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17(1):101–107

    Article  CAS  Google Scholar 

  16. Farooque F, Jacombs AS, Roussos E, Read JW, Dardano AN, Edye M, Ibrahim N (2016) Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg 86(1–2):79–83

    Article  Google Scholar 

  17. Ibarra-Hurtado TR, Nuño-Guzmán CM, Echeagaray-Herrera JE, Robles-Vélez E, de Jesús G-J (2009) Use of botulinum toxin type a before abdominal wall hernia reconstruction. World J Surg 33(12):2553–2556

    Article  Google Scholar 

  18. Berrevoet F (2018) Prevention of incisional hernias after open abdomen treatment. Front Surg 5:11

    Article  Google Scholar 

  19. Bueno-Lledó J, Torregrosa-Gallud A, Jiménez-Rosellón R, Carbonell-Tatay F, García-Pastor P, Bonafé-Diana S, Iserte-Hernández J (2017) Preoperative preparation of «loss of domain» hernia Progressive pneumoperitoneum and botulinum toxin type A. Cir Esp 95(5):245–253

    Article  Google Scholar 

  20. Ibarra-Hurtado TR, Nuño-Guzmán CM, Miranda-Díaz AG, Troyo-Sanromán R, Navarro-Ibarra R, Bravo-Cuellar L (2014) Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia 18:647–652

    Article  CAS  Google Scholar 

  21. Bueno-Lledó J, Torregrosa Gallud A, Jiménez Rosellón R, Carbonell Tatay F, García Pastor P, Bonafé Diana S, Iserte Hernández J (2018) Preoperative combination of progressive pneumoperitoneum and botulinum toxin type A in patients with loss of domain hernia. Surg Endoscoscopy 32(8):3599–3608

    Article  Google Scholar 

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Correspondence to Vanesa Catalán-Garza.

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Catalán-Garza V declares that she has no conflict of interest. Peña-Soria MJ declares that she has no conflict of interest. Sáez-Carlin P declares that she has no conflict of interest. Cabeza-Gómez JJ declares that he has no conflict of interest. García-Fernández A declares that he has no conflict of interest. Torres-García AJ declares that he has no conflict of interest.

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Catalán-Garza, V., Peña-Soria, M., Sáez-Carlin, P. et al. Long-term results of botulinum toxin type A in complex abdominal wall repair and review of the literature. Updates Surg 72, 1201–1206 (2020). https://doi.org/10.1007/s13304-020-00775-w

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