Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia

Weissler, Jason M.; Lanni, Michael A.; Tecce, Michael G.; Carney, Martin J.; Shubinets, Valeriy; Fischer, John P.

doi:10.1080/2000656x.2017.1285783

Cited by 58 publications

(45 citation statements)

References 29 publications

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“…The combination of a Venetian blind technique with BTA for chemical component separation combines two techniques which synergistically facilitate the restoration of abdominal wall anatomy while providing a flat surface for mesh. Meta‐analysis reveals significant hernia width reduction (mean = 5.79 cm; n = 29; P < 0.001) and lateral abdominal wall muscular lengthening (mean = 3.33 cm; n = 44; P < 0.001) following pre‐operative BTA injections . To our knowledge, this is the first description of this combined technique in the literature.…”

Section: Discussionsupporting

confidence: 88%

“…Meta-analysis reveals significant hernia width reduction (mean = 5.79 cm; n = 29; P < 0.001) and lateral abdominal wall muscular lengthening (mean = 3.33 cm; n = 44; P < 0.001) following pre-operative BTA injections. 10 To our knowledge, this is the first description of this combined technique in the literature. Minimally invasive repair was achieved in all patients in this series and there was no evidence of recurrence at follow-up (median 18.25 months).…”

Section: Discussionmentioning

confidence: 85%

“…There is an emerging body of evidence describing the use of botulinum toxin A (BTA) in managing complex midline incisional ventral hernias . This relatively novel technique utilizes BTA to create temporary flaccid paralysis of abdominal wall muscles to achieve a chemical component separation .…”

Section: Introductionmentioning

confidence: 99%

“…8 There is an emerging body of evidence describing the use of botulinum toxin A (BTA) in managing complex midline incisional ventral hernias. 10 This relatively novel technique utilizes BTA to create temporary flaccid paralysis of abdominal wall muscles to achieve a chemical component separation. 11,12 This adjunct elongates abdominal wall muscles, which facilitates midline abdominal wall closure and ease of minimally invasive repair.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation

Chan

Ravindran

Fan

et al. 2019

ANZ Journal of Surgery

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Background Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. ‘Venetian blinds’ technique of plication in combination with mesh reinforcement, is totally intra‐corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre‐operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. Methods A single‐centre case series was conducted using minimally invasive ‘Venetian blinds’ technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non‐midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200–300 units Botox) 4–6 weeks prior to surgery. Repairs were mesh‐reinforced following fascial closure. Results Twelve (10 female, two male) patients, with a median age 72 years (range 31–83) and body mass index of 27.3 kg/m2 (range 22.8–61.7) were included. The median length of operation was 133 min (range 45–290) and length of hospital stay 3 days (range 1–28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital‐acquired pneumonia and pseudomembranous colitis. Conclusion Minimally invasive ‘Venetian blinds’ technique has promising early results with both midline and non‐midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation

Chan

Ravindran

Fan

et al. 2019

ANZ Journal of Surgery

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“…Despite advances in mesh technology, refinement of surgical techniques, and the advent of myofascial reconstruction techniques, abdominal wall reconstruction (AWR) in these patients is still associated with high rates of recurrence [4][5][6] . In addition, each failed attempt at hernia repair results in higher morbidity, costs, and risk of recurrence for each subsequent repair [7,8] .…”

Section: Introductionmentioning

confidence: 99%

The use of botulinum toxin A in chemical component separation: a review of techniques and outcomes

Elhage¹,

Deerenberg²,

Shao³

et al. 2020

PAR

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How to cite this article: Elhage SA, Deerenberg EB, Shao JM, Augenstein VA, Heniford BT. The use of botulinum toxin A in chemical component separation: a review of techniques and outcomes. Plast Aesthet Res 2020;7:16. http://dx. AbstractFascial closure is crucial for abdominal wall reconstruction (AWR) but can be especially difficult in patients with massive ventral hernias or loss domain. Recently, botulinum toxin A (BTA) has been increasingly utilized as an adjunct in AWR to aid in fascial closure. This review aims to evaluate the current literature on the use of BTA in AWR to assess current treatment regimens, side effects, outcomes and complications. A literature search was performed, yielding 10 studies that met the inclusion criteria. There was a significant amount of heterogeneity in treatment regimens, with studies differing in BTA injection timing, dosage, concentration, and location. The majority of studies showed that injection of BTA preoperatively was able to augment abdominal wall musculature, with many showing a decrease in mean transverse defect size and high rates of successful fascial closure. No major complications were reported from BTA administration, with only mild side effects reported by some studies. The most common side effects include a weak cough or sneeze, bloating, and back pain, which generally all resolved prior to surgery. While BTA appears to be a promising adjunct for AWR, further investigation is needed to determine optimal patient selection and treatment regimens.

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Botulinum Toxin Aided Hernia Repair

Tejirian

Yeung

2019

Robotic Assisted Hernia Repair

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Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia

Cited by 58 publications

References 29 publications

Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation

Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation

The use of botulinum toxin A in chemical component separation: a review of techniques and outcomes

Botulinum Toxin Aided Hernia Repair

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