Botox A Injection for Pain after Laparoscopic Ventral Hernia: A Case Report

Abstract

Botox A provided significant pain control for this patient after laparoscopic ventral hernia repair. Continued prospective study to define long-term outcomes, cost savings, and appropriate timing of injections is underway.

Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair

“…Injections were divided into in six equal volumes of 25 mL. The patient was placed in a lateral position and using high resolution ultrasound guidance, three sites were identified and marked along the anterior axillary line equidistant between the inferior border of the rib cage and anterior superior iliac spine, according to positions identified by Smoot et al . Using aseptic technique, each injection site was anaesthetized with 1% lignocaine to dermis and subdermis.…”

“…Botulinum toxin A (BTA) is a neuromodulating agent that is used for an increasing number of clinical applications including dystonia, spasticity, cerebral palsy, hyperhidrosis, hypersalivation, bladder dysfunction, skin wrinkles and pain management over the last 40 years . There are now a small number of case reports, in both humans and animals, using BTA for the perioperative management of abdominal wall surgery with the aims of: (i) improving analgesia; (ii) using the flaccid relaxation to lengthen the abdominal oblique muscles and facilitate apposition of the edges of the defect akin to the effect of component separation but without disrupting the fascial integrity of the abdominal wall; and (iii) decreasing lateral traction and thus reducing tension before and after surgical repair …”

Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19‐year‐old female

“…2 While effective, this technique necessitates large subcutaneous flaps and is associated with significant wound complications including infection, intra-abdominal abscess, enter cutaneous fistula, and ventral hernia formation. 6,7 Although these complications could be reduced by providing tension in the midline with negative pressure dressing to offset the traction created by the lateral abdominal wall, 8 ventral hernia formation rates were still substantial due to the invasiveness of the technique. 9,10 The use of minimally invasive CST presented a promising option for decreasing complications 11 ; however, it was also associated with high recurrence rates.…”

Contraction of abdominal wall muscles influences size and occurrence of incisional hernia

“…48 Botox® in patients with incisional hernia repair has also shown to significantly improve pain scores and reduce need for opioid analgesia. 49, 50 …”