Chemical components separation with the use of botulinum toxin A: A critical review for correction of ventral hernia

Abstract

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in the abdominal wall musculature. The failure of surgical correction may lead to a more morbid treatment for the patient, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of Botulinum Toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical corrections of ventral hernias.Methods: Using the PubMed database, the keywords 'ventral hernia', and 'botulinum toxin' were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing it`s length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications. Conclusion:The use of BTA seems to be a promising alternative in the management of ventral hernias due to the capacity of reducing tension in the abdominal wall. Given the complexity of such cases, however, more studies are necessary to determine the efficacy of this method.

Vacuum assisted closure with mesh mediated fascial traction of open abdominal wounds and acute fascial dehiscence, a single institution experience

“…Botox injection can be instituted as soon as practical, but MMFT is only commenced once the acute pathology has been dealt with. A standardized technique was used 14 . Bilaterally, 300 IU of Botulinum toxin A (BTA) is injected under ultrasound guidance in each of the three muscle layers of the abdominal wall as soon as is feasible after the index laparotomy or first change of VAC 15 …”

“…A standardized technique was used. 14 Bilaterally, 300 IU of Botulinum toxin A (BTA) is injected under ultrasound guidance in each of the three muscle layers of the abdominal wall as soon as is feasible after the index laparotomy or first change of VAC. 15 Under sterile conditions and a general anaesthetic in the operating theatre, the midline wound is opened or reopened, and dressings removed.…”

“…5,11,12 Botulinum toxin A (BTA) has been used in facilitating chemical components relaxation in abdominal wall reconstruction and management of the open abdomen; it is deemed safe, effective and shown to increase fascial closure rates. [13][14][15] BTA which is commonly used in elective procedures, has also been deemed safe and effective in the emergency setting, but it is much less widely utilized. 16 Previously described techniques do not involve any specific modification to preserve the fascial edges, nor any chemical component separation with BTA.…”

“…It has been shown to achieve high rates of fascial closure with low complication rates 5,11,12 . Botulinum toxin A (BTA) has been used in facilitating chemical components relaxation in abdominal wall reconstruction and management of the open abdomen; it is deemed safe, effective and shown to increase fascial closure rates 13–15 . BTA which is commonly used in elective procedures, has also been deemed safe and effective in the emergency setting, but it is much less widely utilized 16 .…”