Botulinum toxin to avoid component separation in midline large hernias

Bueno-Lledó, José; Martínez-Hoed, Jesús; Torregrosa-Gallud, Antonio; Menéndez-Jiménez, Miriam; Pous‐Serrano, Salvador

doi:10.1016/j.surg.2020.04.050

Cited by 29 publications

(26 citation statements)

References 23 publications

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“…In our opinion, this is exactly where preoperative chemical components separation using botulinum might play a key role. Lledo et al (37) published in 2020 their experience from a comparative study on 80 patients with midline incisional hernias, in which chemical components separation down-staged the required hernia repair type from components separation to a Rives-Stoppa repair with a 100% primary fascial closure achievement rate in the chemical components group and no complications from the injection of botulinum per se. Interestingly, large midline incisional hernias (hernia W3 according to EHS classification) with defects of 12-18 cm in diameter were only included in the study (21).…”

Section: Resultsmentioning

confidence: 99%

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Seretis

Chrysikos

Samolis

et al. 2021

In Vivo

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Background/Aim: Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. Materials and Methods: A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. Results: Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. Conclusion: Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.Abdominal wall hernias represent a common problem in current surgical practice. Over 20% of all abdominal operations performed in the US annually are complicated by development of an incisional hernia (1). In an attempt to identify the key players in the successful treatment of the most challenging subgroup of these hernias, namely the complex hernias, a scheme identifying size and location, contamination and soft tissue infection as well as patient history and risk factors has been proposed (2). Incisional hernias are well known to recur after repair (3), thus underlying the importance of solid knowledge of relevant anatomy, technique and most importantly new adjuncts in treatment. More advanced techniques in hernia repair were developed such as Rives-Stoppa retro-rectus repair and, subsequently, posterior components separation whith the goal to achieve primary and tension-free myo-fascial closure reinforced by mesh placement (4). The goal of this study was to review current evidence regarding the use of botulinum toxin in the treatment of abdominal wall hernia repair, in a critical manner.

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Section: Resultsmentioning

confidence: 99%

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Seretis

Chrysikos

Samolis

et al. 2021

In Vivo

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“…Of these 75 articles, 20 were selected for inclusion. 10e12, 14,21e36 One article was a case-control study, 11 2 articles were non-randomized trials, 34,36 1 was a case series with selected controls, 29 and all other articles were single-arm prospective or retrospective studies. 10,12,14,21e28,30e33,35 Owing to the large number of single-arm studies, a minor deviation from the originally registered protocol 37 took place in the form of the additional use of the MINORS checklist for quality assessment, as this checklist is both applicable for comparative and noncomparative studies.…”

Section: Search and Study Characteristicsmentioning

confidence: 99%

“…Loss of domain ratio >20% or >25% 22,24,25,35 Measurements (hernia width or loss of domain ratio) 14,21,32,34,35 Hernia width >10 cm 23,30 Hernia width cut-off þ loss of domain ratio >20% 14,21 Surgeon preference or expected difficulty closing midline 11,27 Hernia contents cannot be reduced back to abdominal cavity 26 Foreseen problems during surgery 29 Open abdomen 12,28 Undefined/surgeon's decision 10,31,33,36 BT, Botulinum Toxin A; cm, centimeter; PP, progressive pneumoperitoneum.…”

Section: Pp Indications Bt Indicationsmentioning

confidence: 99%

“…40 Costs are rarely reported, but are estimated to be between 400 and 600 euros when BT is injected into the abdominal wall musculature. 21,34 These numbers seem considerable but become less so when reoperations owing to recurrences and severe postoperative complicationsdconsequences of invasive techniques to obtain fascial closuredcan be prevented. PP is a costly procedure, in particular when performed on an inpatient basis.…”

Section: Pp Indications Bt Indicationsmentioning

confidence: 99%

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Fascial closure in giant ventral hernias after preoperative botulinum toxin a and progressive pneumoperitoneum: A systematic review and meta-analysis

Rooijen

Yurtkap

Allaeys

et al. 2021

Surgery

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Background: The primary objective was to assess the perioperative efficacy of the preoperative use of progressive pneumoperitoneum or Botulinum Toxin A injections in ventral hernia repair. Methods: Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar were systematically searched. Studies in English reporting on fascial closure, indications, complications or postoperative outcomes in adult patients that had undergone progressive pneumoperitoneum, Botulinum Toxin A injections, or both before ventral hernia repair were included. Study quality was assessed with the Oxford Levels of Evidence guidelines and the Methodological Index for Non-Randomized Studies criteria. A pooled fascial closure rate and recurrence rate were calculated with random effects models. Results: Twenty studies were included from the 905 identified, comprising the use progressive pneumoperitoneum (n ¼ 11), Botulinum Toxin A (n ¼ 6), and both techniques (n ¼ 3). The overall fascial closure rate was 0.94 (95% confidence interval 0.89e0.98). Indications for the use of progressive pneumoperitoneum or Botulinum Toxin A were based on objective (eg, computed tomography measurements) or subjective measures (eg, foreseen surgical problems). In contrast to the use of Botulinum Toxin A, reported complications with the use of progressive pneumoperitoneum were ample and sometimes severe. The cumulative reported recurrence rate was 0.03 (95% confidence interval 0.01e0.06). Conclusion: Preoperative progressive pneumoperitoneum and Botulinum Toxin A can facilitate fascial closure without causing significant numbers of adverse events. Botulinum Toxin A qualifies for lowthreshold use, yet progressive pneumoperitoneum should be used cautiously owing to a larger number of complications. Definitive recommendations cannot be made as the quality of included studies is low, bias is present, and comparative information is scarce. Registration number Information about the design and conduct of this systematic review has been registered on PROSPERO, registration number CRD42020181679.

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“…is variable according to the characteristics of the incision, location, type, size, preferences of the surgeon, etc. Complex incisional hernias may require abdominal preparation before surgery with infiltration of botulinum toxin and sometimes also with the creation of a progressive pneumoperitoneum [35,36]. Hernia repair is thus characterized by the increasing use of prosthetic meshes made of pure or different hybrid biomaterials, depending on the type of surgery [37].…”

Section: Introductionmentioning

confidence: 99%

Prosthetic Meshes for Hernia Repair: State of Art, Classification, Antimicrobial Approaches, and Fabrication Methods

Serrano‐Aroca¹,

Pous‐Serrano²

2021

Preprint

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Worldwide, hernia repair represents one of the most frequent surgical procedures encompassing a global market valued at several billion dollars. This type of surgery usually requires the implantation of a mesh that needs the appropriate chemical, physical and biological properties for the type of repair. This review thus presents a description of the types of hernias, current hernia repair methods, and the state of the art of prosthetic meshes for hernia repair providing the most important meshes used in clinical practice by surgeons working in this area classified according to their biological or chemical nature, morphology and whether bioabsorbable or not. We emphasise the importance of surgical site infection in herniatology, how to deal with this microbial problem, and we go further into the future research lines on the production of advanced antimicrobial meshes to improve hernia repair and prevent microbial infections, including multidrug-resistant strains. A great deal of progress has been made in this biomedical field in the last decade. However, we are still far from an ideal antimicrobial mesh that can also provide excellent integration to the abdominal wall, mechanical performance, low visceral adhesion and minimal inflammatory or foreign body reactions, among many other problems.

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Botulinum toxin to avoid component separation in midline large hernias

Cited by 29 publications

References 23 publications

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Fascial closure in giant ventral hernias after preoperative botulinum toxin a and progressive pneumoperitoneum: A systematic review and meta-analysis

Prosthetic Meshes for Hernia Repair: State of Art, Classification, Antimicrobial Approaches, and Fabrication Methods

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