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

Abstract

Background Incisional hernias are a complication in 10% of all open abdominal operations and can result in significant morbidity. The purpose of this study is to determine if inhibiting abdominal muscle contraction influences incisional hernia formation during laparotomy healing. We hypothesize that reducing abdominal musculature deformation reduces incisional hernia occurrence and size. Study Design Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with one mid-incision, fast-absorbing suture. Three groups were compared: a SHAM group (SHAM; n = 6) received no laparotomies while the Saline Hernia (SH; n = 6) and Botox Hernia (BH; n = 6) groups were treated once with equal volume saline or Botulinum Toxin (Botox®, Allergan) before the incomplete laparotomy closure. On post-operative day 14, the abdominal wall was examined for herniation and adhesions and contractile forces were measured for abdominal wall muscles. Results No hernias developed in SHAM rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared to those in the SH group (p < 0.05). The BH group had weaker abdominal muscles compared to the SHAM and SH groups (p < 0.05). Conclusions In our rat model, partial paralysis of abdominal muscles reduces the number and size of incisional hernias. These results confirm abdominal wall muscle contractions play a significant role in the pathophysiology of incisional hernia formation.

Incisional infections associated with ventral midline celiotomy in horses

“…14 The healing tissue and the sutures are under tension produced by abdominal pressure and contraction of the flank muscles that insert within the linea alba. [13][14][15][16][17] The tension along the incision can result in hernia formation or dehiscence if the suture line fails or weakens prior to body wall healing. Tension along the incision also produces cyclic strain that stimulates fibroblast proliferation and alignment of the fibroblasts perpendicular to the direction of the strain during remodeling, accelerating wound proliferation and remodeling.…”

“…These events occur in a precisely synchronized pattern to reestablish the continuity and strength of the linea alba 14 . The healing tissue and the sutures are under tension produced by abdominal pressure and contraction of the flank muscles that insert within the linea alba 13–17 . The tension along the incision can result in hernia formation or dehiscence if the suture line fails or weakens prior to body wall healing.…”

Component separation of abdominal wall with intraoperative botulinum A presents satisfactory outcomes in large incisional hernias: a case report

“…BTA is a therapeutic option to decrease the suture tension and rate of hernia recurrence. It is a neurotoxin that provokes a reversible chemical denervation of the muscle, manifested as a flaccid muscular paralysis that takes effect from two days after application and lasts for 6–9 months [9] , [12] , [15] , [16] , [23] . It reduces the thickness of the abdominal wall, increasing its length, allowing hernial reduction and therefore allowing closure without tension.…”

“…The bigger the hernia, the more difficult it is to repair without tension, which is fundamental for myofascial closure of the abdominal wall and reducing the risk of recurrence. Large hernial defects treatment are related to postoperative complications, including compartment syndrome; this is a concern for the surgeon because of the difficulty of treatment, as well as high rates of recurrence after surgical correction [1] , [8] , [9] , [10] , [11] .…”

Prevention of Complications of Incisional Hernia Repair: Current Problem State (Review)

“…Currently, the technology based on botulinum toxin type A injected in lateral abdominal muscles is gaining widespread appreciation. The injections have a paralytic effect on abdominal wall muscles increasing the abdominal cavity volume that further enables to eliminate hernia defect tension-free and avoid developing intraabdominal hypertension [39]. The technique has become relevant in patients with large hernias and loss of domain (loss of domain is abdominal cavity volume loss due to the fact that the organs are constantly in hernia sac is determined when a hernia sac occupies over 25% abdominal cavity) [40].…”