Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management

Abstract

BTA application in lateral abdominal muscles decreases its thickness and increases its length in abdominal wall hernia patients secondary to open abdomen management.

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

“…Similarly, both studies by Ibarra-Hurtado et al 19,20 showed significant reductions of the transverse hernia defect (mean decrease, 4.79 cm; 95% confidence interval [CI], 3.63–6.31; P < 0.001 and 5.25 cm; 95% CI, 3.59–6.91; P < 0.001) secondary to administrations of 500 U of BTA. In a comparable study, administration of 100 U of BTA resulted in a small and statistically nonsignificant transverse reduction of the hernia defect after 4 weeks.…”

“…The administered total doses were 100 U 18,21 , 300 U 16,17 , and 500 U 19,20 . Four studies reported that BTA was diluted with 0.9% saline before administration to the following final concentrations: 2 U/ml 16,17 , 50 U/ml 21 , or 100 U/ml 19 . The BTA dilution was then divided into 6 16,17 to 10 18–21 equal doses.…”

“…The BTA dilution was then divided into 6 16,17 to 10 18–21 equal doses. Ultrasonographic 16,17 or electromyographic 19–21 guidance allowed identification of the 3 muscle layers (external abdominal oblique, internal abdominal oblique, and transversus abdominis) at the 3 16,17 to 5 18–21 planned injection sites on each side of the abdomen. The BTA dilution was equally administrated into each of the 3 muscle layers at each injection site, resulting in a total of 9 16,17 to 15 18–21 distributions on each side of the abdomen.…”

“…Ibarra-Hurtado et al 19,20 published 2 studies including a total of 29 patients with midline defects who received a total dose of 500 U BTA 4 weeks before the hernia repair. Surgical repair was done with retromuscular mesh repair or simple suture closure without mesh.…”

“…Successful primary fascial closure was achieved in all patients. However, 15 patients (53% 19 and 50% 20 ) required additional CST for abdominal closure.…”