Preoperative botulinum toxin A injection in complex abdominal wall reconstruction– a propensity-scored matched study

Deerenberg, Eva B.; Shao, Jenny M.; Elhage, Sharbel A.; López, Robert; Ayuso, Sullivan A.; Augenstein, Vedra A.

doi:10.1016/j.amjsurg.2021.01.010

Cited by 27 publications

(23 citation statements)

References 22 publications

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“…Type rate and comparable recurrence rates, which were mostly associated with failure to achieve fascial approximation (39). Safety profile of preoperative botulinum injection has been well reported with only pain usually expressed only in a minority of patients (40).…”

Section: Studymentioning

confidence: 91%

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Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Seretis

Chrysikos

Samolis

et al. 2021

In Vivo

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Background/Aim: Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. Materials and Methods: A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. Results: Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. Conclusion: Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.Abdominal wall hernias represent a common problem in current surgical practice. Over 20% of all abdominal operations performed in the US annually are complicated by development of an incisional hernia (1). In an attempt to identify the key players in the successful treatment of the most challenging subgroup of these hernias, namely the complex hernias, a scheme identifying size and location, contamination and soft tissue infection as well as patient history and risk factors has been proposed (2). Incisional hernias are well known to recur after repair (3), thus underlying the importance of solid knowledge of relevant anatomy, technique and most importantly new adjuncts in treatment. More advanced techniques in hernia repair were developed such as Rives-Stoppa retro-rectus repair and, subsequently, posterior components separation whith the goal to achieve primary and tension-free myo-fascial closure reinforced by mesh placement (4). The goal of this study was to review current evidence regarding the use of botulinum toxin in the treatment of abdominal wall hernia repair, in a critical manner.

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Section: Studymentioning

confidence: 91%

“…Propensity scored matched study -Large study groups 2021 (39) 145 patients undergoing abdominal wall reconstruction -Fascial approximation rates as outcome versus 75 patients undergoing abdominal wall reconstruction with botulinum injection preoperatively Deerenberg et al…”

Section: Studymentioning

confidence: 99%

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Seretis

Chrysikos

Samolis

et al. 2021

In Vivo

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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%

“…Combined, the 23 studies include 995 patients of which 664 have been treated with BTA. The median defect width from 15 studies [7,[16][17][18][19][20][21][22][23][25][26][27][28][29][30] that exclusively describe patients with a midline ventral hernia is 13.9 cm (IQR 11.4-14.7). Seven [15, 18, 24-26, 30, 31] of 20 studies that inject BTA prior to a hernia repair report a specific indication for the use of BTA.…”

Section: Study-and Patient Characteristicsmentioning

confidence: 99%

“…One study [30] uses three-to-five injection bilaterally. Fifteen studies [14,15,17,18,20,21,[24][25][26][30][31][32][33][34][35] inject all three muscles (external oblique, internal oblique and transversus abdominis), whereas two studies [22,27] spare the transversus abdominis from injection. One study [16] specifically investigates the standard three-layer against the selective two-layer muscle injection.…”

Section: Bta Characteristicsmentioning

confidence: 99%

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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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Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models

Holland,

Lorenz,

Cavanagh

et al. 2024

JAMA Netw Open

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ImportanceArtificial intelligence (AI) has permeated academia, especially OpenAI Chat Generative Pretrained Transformer (ChatGPT), a large language model. However, little has been reported on its use in medical research.ObjectiveTo assess a chatbot’s capability to generate and grade medical research abstracts.Design, Setting, and ParticipantsIn this cross-sectional study, ChatGPT versions 3.5 and 4.0 (referred to as chatbot 1 and chatbot 2) were coached to generate 10 abstracts by providing background literature, prompts, analyzed data for each topic, and 10 previously presented, unassociated abstracts to serve as models. The study was conducted between August 2023 and February 2024 (including data analysis).ExposureAbstract versions utilizing the same topic and data were written by a surgical trainee or a senior physician or generated by chatbot 1 and chatbot 2 for comparison. The 10 training abstracts were written by 8 surgical residents or fellows, edited by the same senior surgeon, at a high-volume hospital in the Southeastern US with an emphasis on outcomes-based research. Abstract comparison was then based on 10 abstracts written by 5 surgical trainees within the first 6 months of their research year, edited by the same senior author.Main Outcomes and MeasuresThe primary outcome measurements were the abstract grades using 10- and 20-point scales and ranks (first to fourth). Abstract versions by chatbot 1, chatbot 2, junior residents, and the senior author were compared and judged by blinded surgeon-reviewers as well as both chatbot models. Five academic attending surgeons from Denmark, the UK, and the US, with extensive experience in surgical organizations, research, and abstract evaluation served as reviewers.ResultsSurgeon-reviewers were unable to differentiate between abstract versions. Each reviewer ranked an AI-generated version first at least once. Abstracts demonstrated no difference in their median (IQR) 10-point scores (resident, 7.0 [6.0-8.0]; senior author, 7.0 [6.0-8.0]; chatbot 1, 7.0 [6.0-8.0]; chatbot 2, 7.0 [6.0-8.0]; P = .61), 20-point scores (resident, 14.0 [12.0-7.0]; senior author, 15.0 [13.0-17.0]; chatbot 1, 14.0 [12.0-16.0]; chatbot 2, 14.0 [13.0-16.0]; P = .50), or rank (resident, 3.0 [1.0-4.0]; senior author, 2.0 [1.0-4.0]; chatbot 1, 3.0 [2.0-4.0]; chatbot 2, 2.0 [1.0-3.0]; P = .14). The abstract grades given by chatbot 1 were comparable to the surgeon-reviewers’ grades. However, chatbot 2 graded more favorably than the surgeon-reviewers and chatbot 1. Median (IQR) chatbot 2-reviewer grades were higher than surgeon-reviewer grades of all 4 abstract versions (resident, 14.0 [12.0-17.0] vs 16.9 [16.0-17.5]; P = .02; senior author, 15.0 [13.0-17.0] vs 17.0 [16.5-18.0]; P = .03; chatbot 1, 14.0 [12.0-16.0] vs 17.8 [17.5-18.5]; P = .002; chatbot 2, 14.0 [13.0-16.0] vs 16.8 [14.5-18.0]; P = .04). When comparing the grades of the 2 chatbots, chatbot 2 gave higher median (IQR) grades for abstracts than chatbot 1 (resident, 14.0 [13.0-15.0] vs 16.9 [16.0-17.5]; P = .003; senior author, 13.5 [13.0-15.5] vs 17.0 [16.5-18.0]; P = .004; chatbot 1, 14.5 [13.0-15.0] vs 17.8 [17.5-18.5]; P = .003; chatbot 2, 14.0 [13.0-15.0] vs 16.8 [14.5-18.0]; P = .01).Conclusions and RelevanceIn this cross-sectional study, trained chatbots generated convincing medical abstracts, undifferentiable from resident or senior author drafts. Chatbot 1 graded abstracts similarly to surgeon-reviewers, while chatbot 2 was less stringent. These findings may assist surgeon-scientists in successfully implementing AI in medical research.

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Preoperative botulinum toxin A injection in complex abdominal wall reconstruction– a propensity-scored matched study

Cited by 27 publications

References 22 publications

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes

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

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models

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