Botulinum Toxin A as an Adjunct to Abdominal Wall Reconstruction for Incisional Hernia

Abstract

Background:Repair of large incisional hernias remains a surgical and costly challenge. Temporary paralysis of the lateral abdominal wall muscles with topical administration of botulinum toxin A (BTA) is a new therapeutic concept, which may obviate the need for component separation technique (CST) for repair of large incisional hernias. Current literature on the administration of BTA as adjunct to surgical repair of abdominal incisional hernias was investigated.Methods:The electronic databases PubMed and Embase were searched for eligible studies. Two independent investigators evaluated the literature. Data were sought regarding primary fascial closure with and without CST, safety, hernia recurrence, method of application, and preoperative radiological imaging.Results:Six cohort studies including a total of 133 patients receiving BTA were identified. No randomized or case–control studies were found. In total, 83.5% of the patients achieved primary fascial closure. Supplemental CST was necessary in 24.1% of the patients. Two patients developed hernia recurrence during follow-up. No postoperative complications or adverse events were considered related to the administration of BTA, except for impairment of postoperative coughing and sneezing. Additionally, radiological imaging showed that BTA increased the length of lateral abdominal muscles before surgery.Conclusions:Preoperative administration of BTA increases muscle length and may facilitate primary fascial closure. Optimal administration is at least 2 weeks before repair, whereas the optimal dose of BTA remains to be defined. Carefully designed randomized controlled trials are warranted to identify patients who would benefit from BTA and to eliminate the confounding effect of CST.

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

“…Botulinum toxin A (BTA) is a neurotoxic protein produced by Clostridium botulinum, which causes reversible (Temporary) muscular paralysis by inhibiting the release of acetylcholine at the neuromuscular junction . It is given intramuscularly with maximum effect seen within 2 weeks of administration and lasts for about 2.5 months .…”

“…Several studies have subsequently been done in order to assess efficacy, complications, and ideal dosage and technique, but none are randomized control trials. The cohorts are investigated in a systemic review involving 133 patients receiving BTA as an adjunct to surgical repair of abdominal incisional hernias . The studies varied in BTA doses from 300 to 500 U, and injection sites of 3 and 5 per laterality.…”

“…12 Botulinum toxin A (BTA) is a neurotoxic protein produced by Clostridium botulinum, which causes reversible (Temporary) muscular paralysis by inhibiting the release of acetylcholine at the neuromuscular junction. 4 It is given intramuscularly with maximum effect seen within 2 weeks of administration and lasts for about 2.5 months. 13 Presently, it is used in a wide range of clinical conditions such as skin wrinkles, spastic muscle disorders, hyperhidrosis, and bladder dysfunction and has various other cosmetic 14 and non-cosmetic 15 uses.…”

“…The cohorts are investigated in a systemic review involving 133 patients receiving BTA as an adjunct to surgical repair of abdominal incisional hernias. 4 The studies varied in BTA doses from 300 to 500 U, and injection sites of 3 and 5 per laterality. In total, 83.5% of the patients achieved primary fascial closure, CST was still necessary in 24.1% of patients.…”

“…3 Surgical repair of abdominal wall hernias alongside the injection of Botulinum toxin A (BTA) to lateral abdominal musculature is a new therapeutic concept that may preclude the need for CST for the repair of large abdominal wall defects. 4 The goal was to perform a tension-free closure, with abdominal wall dynamic stability while optimizing aesthetic appearance. We are reporting the first case utilizing BTA as an adjunct for surgical hernia repair in Saudi Arabia performed in January 2017.…”