Outcomes of Chemical Component Paralysis Using Botulinum Toxin for Incisional Hernia Repairs

Zendejas, Benjamin; Khasawneh, Mohammad A.; Srvantstyan, Boris; Jenkins, Donald H.; Schiller, Henry J.; Zielinski, Martin D.

doi:10.1007/s00268-013-2211-6

Cited by 88 publications

(80 citation statements)

References 30 publications

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“…BTA was administered through 3 16,17 or 5 18–21 injection sites on each side of the abdomen. The administered total doses were 100 U 18,21 , 300 U 16,17 , and 500 U 19,20 .…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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. 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.…”

Section: Resultsmentioning

confidence: 99%

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

Soltanizadeh

Helgstrand

Jørgensen

2017

Plastic and Reconstructive Surgery - Global Open

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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.

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“…BTA was administered through 3 16,17 or 5 18–21 injection sites on each side of the abdomen. The administered total doses were 100 U 18,21 , 300 U 16,17 , and 500 U 19,20 .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Soltanizadeh

Helgstrand

Jørgensen

2017

Plastic and Reconstructive Surgery - Global Open

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“…48 Botox® in patients with incisional hernia repair has also shown to significantly improve pain scores and reduce need for opioid analgesia. 49, 50 …”

Section: Discussionmentioning

confidence: 99%

Contraction of abdominal wall muscles influences size and occurrence of incisional hernia

Lien

Wollstein

et al. 2015

Surgery

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Background Incisional hernias are a complication in 10% of all open abdominal operations and can result in significant morbidity. The purpose of this study is to determine if inhibiting abdominal muscle contraction influences incisional hernia formation during laparotomy healing. We hypothesize that reducing abdominal musculature deformation reduces incisional hernia occurrence and size. Study Design Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with one mid-incision, fast-absorbing suture. Three groups were compared: a SHAM group (SHAM; n = 6) received no laparotomies while the Saline Hernia (SH; n = 6) and Botox Hernia (BH; n = 6) groups were treated once with equal volume saline or Botulinum Toxin (Botox®, Allergan) before the incomplete laparotomy closure. On post-operative day 14, the abdominal wall was examined for herniation and adhesions and contractile forces were measured for abdominal wall muscles. Results No hernias developed in SHAM rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared to those in the SH group (p < 0.05). The BH group had weaker abdominal muscles compared to the SHAM and SH groups (p < 0.05). Conclusions In our rat model, partial paralysis of abdominal muscles reduces the number and size of incisional hernias. These results confirm abdominal wall muscle contractions play a significant role in the pathophysiology of incisional hernia formation.

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“…The search for painless hernia surgery has resulted in some interesting work by Zendejas and his group, published in this issue of the World Journal of Surgery [1]. Botulinum toxin A (Botox), a potent muscle-paralyzing agent, is commonly used for various medical and cosmetic indications.…”

Section: I've Never Been To a Botox Party…mentioning

confidence: 99%