Botulinum toxin A–induced paralysis of the lateral abdominal wall after damage-control laparotomy

Zielinski, Martin D.; Kuntz, Melissa; Zhang, Xiao Ming; Zagar, Abigail E.; Khasawneh, Mohammad A.; Zendejas, Benjamin; Polites, Stephanie F.; Ferrara, Michael; Harmsen, William S.; Ballman, Karla S.; Park, Myung S.; Schiller, Henry J.; Dries, David J.; Jenkins, Donald H.

doi:10.1097/ta.0000000000000917

Cited by 22 publications

(15 citation statements)

References 27 publications

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“…10 CT-guided BTI alone and in conjunction with PPP has successfully been utilized in GIH earlier this year in a series of 10 patients. 11 Our initial experiences with targeted BTI for GIH repair in this series also bodes favorably for their enhanced use.…”

Section: Discussionmentioning

confidence: 83%

Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias

et al. 2019

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Background. Giant inguinoscrotal hernias (GIH) are defined as groin hernias extending below the mid-thigh when standing, often significantly encumbering activities of daily living. To date, there are no reports utilizing the combination of progressive pneumoperitoneum (PPP), botulinum toxin A injection (BTI), and enhanced view-totally extraperitoneal (eTEP) technique for GIH repair. In this report, we present 2 such cases of this unique minimally invasive multidisciplinary approach to address GIH. Series Presentation. Two individuals with lifelong complaints of GIH presented for elective hernia repair, each with significant morbidity relating to their pathology and profound loss of abdominal domain. Four weeks prior to surgery, BTI was administered to the lateral abdominal compartment muscles to facilitate regional paralysis, followed by PPP to develop larger intraabdominal domain. Utilizing the eTEP access technique and transversus abdominis release, a wide retromuscular dissection was performed to aid in the increase of intraabdominal domain and to develop a large space for mesh placement. Reconstruction including partial scrotectomy and scrotoplasty using adjacent tissue transfer technique was completed. Both patients tolerated the procedures well without recurrence in the first postoperative year. Conclusion. In this article, we present the first series of GIH patients undergoing combined PPP, BTI, and eTEP access approach to retromuscular dissection. This multidisciplinary approach to patient care has proven both safe and effective.

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Section: Discussionmentioning

confidence: 83%

Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias

et al. 2019

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“…Los trabajos de Zielinski y cols. 8,14 se centran en el manejo del abdomen abierto y el uso de la TBA como ayuda en el cierre de la pared abdominal, sin incluir pacientes con reparaciones previas de la pared abdominal. Los trabajos de Ibarra y cols.…”

Section: Resultsunclassified

“…El intervalo más frecuente es de 28-30 días. En el trabajo de Zielinski 14 del 2016, el intervalo hasta el cierre de la pared es de 1.8 días, aunque en este caso se trata de pacientes con abdomen abierto y no de pacientes con hernias ventrales.…”

Section: Resultsunclassified

“…La revisión se limitó a estudios en inglés y en español. Los criterios de búsqueda arrojaron 315 resultados, de los que se seleccionan 22 artículos originales, que se incluyen en esta revisión 1-3, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Solo se analizan los estudios primarios que informan de los resultados del uso preoperatorio de la TBA en la reparación de las hernias ventrales.…”

Section: Materials Y Métodosunclassified

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Using botilinum toxin for abdominal wall reconstruction

Gallego-Otaegui¹,

Osorio-Capitán²,

Carballo-Rodríguez³

et al. 2021

Rev Hispanoam Hernia

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Conflicto de intereses: Los autores declaran no tener conflicto de intereses. RESUMENObjetivo: Revisar la literatura actual sobre el uso de la toxina botulínica tipo A (TBA) como complemento en la preparación preoperatoria de la cirugía de pared abdominal compleja. Material y métodos:Se realiza una búsqueda en las bases de datos electrónicas PubMed y Cochrane Library sobre el uso de la TBA. Tras una La mayoría de trabajos no describen apenas complicaciones con su uso, salvo distensión abdominal, tos o dolores de espalda, todas ellas de intensidad leve y limitadas en el tiempo, controlables con el uso de una faja abdominal y en general bien toleradas por los pacientes.Conclusiones: El uso de la TBA es cada vez más frecuente en la cirugía de pared abdominal, aunque los regímenes para su aplicación y dosis siguen sin estandarizarse. Existe una gran heterogeneidad entre los estudios. No obstante, en la mayoría de trabajos se demuestra que, tras la infiltración con TBA, los músculos de la pared abdominal lateral se elongan y se adelgazan, lo que disminuye el diámetro transversal del defecto.Gracias a este efecto se consigue el cierre fascial en la mayoría de los pacientes, beneficio en el control del dolor posoperatorio y no se han observado efectos adversos graves asociados a su uso.Palabras clave: Toxina botulínica A, reconstrucción de la pared abdominal, hernia con pérdida de derecho a domicilio, separación de componentes química, hernia incisonal, neumoperitoneo preoperatorio progresivo.

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“…Study-and patient characteristics are presented in Table 1. We identified one RCT [14], two prospective comparative studies [15,16], three retrospective comparative studies [17][18][19], six prospective cohort studies [7,[20][21][22][23][24], and eleven retrospective cohort studies [25][26][27][28][29][30][31][32][33][34][35], all published between 2009 and 2021. Eighteen studies describe the injection of BTA to optimize patients prior to ventral hernia repair and one study [19] performs intraoperative BTA injections during open hernia repair.…”

Section: Study-and Patient Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction

Timmer

Claessen

Atema

et al. 2021

Hernia

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Purpose To systematically review technical aspects and treatment regimens of botulinum toxin A (BTA) injections in the lateral abdominal wall musculature. We also investigated the effect of BTA on abdominal muscle- and hernia dimensions, and clinical outcome. Methods PubMed, EMBASE, CENTRAL, and CINAHL were searched for studies that investigate the injection of BTA in the lateral abdominal wall muscles. Study characteristics, BTA treatment regimens, surgical procedures, and clinical outcomes are presented descriptively. The effect of BTA on muscle- and hernia dimensions is analyzed using random-effects meta-analyses, and exclusively for studies that investigate ventral incisional hernia patients. Results We identified 23 studies, comprising 995 patients. Generally, either 500 units of Dysport® or 200–300 units of Botox® are injected at 3–5 locations bilaterally in all three muscles of the lateral abdominal wall, about 4 weeks prior to surgery. No major procedural complications are reported. Meta-analyses show that BTA provides significant elongation of the lateral abdominal wall of 3.2 cm per side (95% CI 2.0–4.3, I2 = 0%, p < 0.001); 6.3 cm total elongation, and a significant but heterogeneous decrease in transverse hernia width (95% CI 0.2–6.8, I2 = 94%, p = 0.04). Furthermore, meta-analysis shows that BTA pretreatment in ventral hernia patients significantly increases the fascial closure rate [RR 1.08 (95% CI 1.02–1.16, I2 = 0%, p = 0.02)]. Conclusion The injection technique and treatment regimens of botulinum toxin A as well as patient selection require standardization. Bilateral pretreatment in hernia patients significantly elongates the lateral abdominal wall muscles, making fascial closure during surgical hernia repair more likely. Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42020198246).

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Botulinum toxin A–induced paralysis of the lateral abdominal wall after damage-control laparotomy

Cited by 22 publications

References 27 publications

Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias

Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias

Using botilinum toxin for abdominal wall reconstruction

A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction

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