Preoperative botulinum toxin type A: A case report of a proposed new strategy for giant hiatal hernia management

Tustumi, Francisco; Bianchi, E; Szachnowicz, Sérgio; Cedro, Rider; Neto, Antônio Afonso de Miranda; Morrell, André Luiz Gioia; Abdalla, René Jorge; Sallum, Rubens Antônio Aissar; Cecconello, Ivan

doi:10.1002/ccr3.3416

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…This clinical case showed the successful treatment of a giant HH using adjuvant BTX injection to increase the abdominal compartment as already described in the treatment of complex ventral hernias of the abdominal wall [6,7]. Nonetheless, its application in the treatment of HHs was only described once [4].…”

Section: Discussionsupporting

confidence: 52%

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Adjuvant Botulinum Toxin Type A on the Management of Giant Hiatal Hernia: A Case Report

Henriques,

Rodrigues,

Carvalho

et al. 2024

Cureus

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The management of giant hiatal hernias (HHs) remains challenging and is associated with a high risk of recurrence. Currently, several strategies are used to reduce recurrence, and a newly proposed trend is the administration of adjuvant botulinum toxin type A (BTX), a procedure already performed in complex ventral hernias. Here, we present a case of a 63-year-old man with a giant paraesophageal HH type IV containing the entire stomach and transverse colon with loss of domain, who underwent adjuvant BTX and subsequently laparoscopic hiatoplasty with a biological mesh with partial fundoplication. At six months' follow-up, the patient reported a significant improvement in the quality of life without dysphagia or gastroesophageal reflux and with a good respiratory function. A control computed tomography was performed, which documented a partial recurrence of HH, completely asymptomatic. This clinical case showed the successful treatment of a giant HH using adjuvant BTX injection to increase abdominal wall compliance as had already been described in the treatment of complex ventral hernia. Thus, the use of BTX is a promising strategy for selected cases of giant HHs mainly if there is a loss of domain; however, more case series and controlled trials are needed to show the reproducibility of the benefit of this strategy.

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Section: Discussionsupporting

confidence: 52%

“…A new strategy proposed is the administration of adjuvant botulinum toxin type A (BTX), a procedure already performed in complex ventral hernias [4]. BTX is a neurotoxin produced by Clostridium botulinum, and serotype A is the most powerful.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Botulinum Toxin Type A on the Management of Giant Hiatal Hernia: A Case Report

Henriques,

Rodrigues,

Carvalho

et al. 2024

Cureus

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“…Authors continue to describe BTX use for various other general surgical procedures. A number of authors have documented their successful use of BTX to help with the repair of challenging inguino-scrotal hernias (34)(35)(36)(37), as well as abdominal wall defects in children (38,39) and in the practise of giant hiatus hernia repair (40).…”

Section: Discussionmentioning

confidence: 99%

The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure

Whitehead-Clarke

Windsor

2021

Front. Surg.

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Abdominal wall surgeons have developed a host of tools to help facilitate fascial closure. Botulinum toxin A is one of the most recently identified treatments and has grown in popularity over recent years; showing great promise in a number of case series and cohort studies. The toxin paralyses lateral abdominal wall muscles in order to increase laxity of the tissues—facilitating medialisation of the rectus muscles. Several research groups around the world are developing expertise with its use-uncovering its potential. We present a review of the relevant literature over the last two decades, summarising the key evidence behind its indications, dosing and effects.

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“…This toxin blocks the release of acetylcholine in the terminal cholinergic nerve [9], causing a temporary loss of muscle tone, stretching and decreasing muscle thickness [8,10] -a mechanism capable of decreasing intra-abdominal pressure, avoiding herniation [10][11][12]. Such a strategy has already been described in the treatment of bulky hiatus hernia and could also be used as a tactic to prevent the migration of abdominal viscera to the chest after esophagectomy [13].…”

Section: Discussionmentioning

confidence: 99%

Abdominal Viscera Migration Performing Hemodynamic Instability after Esophagectomy: A Case Report

Lima

Bianchi

Aranha

et al. 2021

Gastrointest Tumors

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Hiatal hernia is a rare postoperative complication of esophagectomy in the treatment of esophageal cancer. Although rare, its incidence increased after the establishment of minimally invasive surgical techniques. The patient is usually oligosymptomatic, and the diagnosis is made in the late postoperative period, during outpatient follow-up. The initial presentation of hiatus hernia with hemodynamic instability is a rare condition that has never been described in the literature before. In the following report, we address the clinical picture, diagnosis, and treatment for this condition, discussing the main nuances of the literature.

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Preoperative botulinum toxin type A: A case report of a proposed new strategy for giant hiatal hernia management

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 4 publications

References 14 publications

Adjuvant Botulinum Toxin Type A on the Management of Giant Hiatal Hernia: A Case Report

Adjuvant Botulinum Toxin Type A on the Management of Giant Hiatal Hernia: A Case Report

The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure

Abdominal Viscera Migration Performing Hemodynamic Instability after Esophagectomy: A Case Report

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