The outcome of pre-operative botulinum toxin in the treatment of large incisional hernias

Tejashree Gokul Sonawane; Abhay Chaudhari

doi:10.18203/2349-2902.isj20222411

Authors

Tejashree Gokul Sonawane Department of Surgery, N. K. P. Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
Abhay Chaudhari Department of Surgery, N. K. P. Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20222411

Keywords:

Botulinum toxin, Incisional hernias, Abdominal cavity, Loss of domain hernia

Abstract

Large incisional hernias with loss of domain represents a challenge for the surgeon. Pre-operative tools such as progressive pneumoperitoneum or botulinum toxin type A have been reported as useful tools for effective and successful surgical procedure in patients with large incisional hernias. Both the mentioned procedures are complementary to hernia repair, using no-strain mesh techniques that support patients’ integral management. The objective of current investigation was to assess the potential of pre-operative botulinum toxin in the treatment of large incisional hernias. Thirteen patients with large incisional hernias were investigated and examined for different parameters including diameters of the abdominal cavity and hernia sac, volume of the contents of incisional hernia and volume of the abdominal cavity which were calculated from CT scan. The current investigation was carried for a duration of two years from December 2020 and January 2022. After thorough clinical examination patients were operated for ventral incisional hernia repair. Eleven patients underwent complete repair of abdominal wall; one patient underwent mesh bridging and one patient required onlay repair. Botulinum toxin was observed to be a safe technique, which has good patient tolerance and can constitute as an effective preoperative tool in the treatment of large incisional hernia. This technique was observed to be aidful in significantly reducing the hernia content into the abdominal cavity, which in turn is an important factor in the treatment of large incisional hernia.

Metrics

Metrics Loading ...

Author Biography

Tejashree Gokul Sonawane, Department of Surgery, N. K. P. Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Surgery

References

Jensen KK, Arnesen RB, Christensen JK, Bisgaard T, Jørgensen LN. Large Incisional Hernias Increase in Size. J Surg Res. 2019;244:160-5.

Jensen KK, East B, Jisova B, Cano ML, Cavallaro G, Jørgensen LN, et al. The European Hernia Society Prehabilitation Project: a systematic review of patient prehabilitation prior to ventral hernia surgery. Hernia. 2022;26(3):715-26.

Martínez B, Soria MJ, Gómez JJ, Valladolid D, Gamarra M, Pérez C, et al. Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study. Hernia. 2017;21(2):253-60.

Mathes T, Prediger B, Walgenbach M, Siegel R. Mesh fixation techniques in primary ventral or incisional hernia repair. Cochrane Database Syst Rev. 2021;5(5):CD011563.

Sun P, Cheng X, Deng S, Hu Q, Sun Y, Zheng Q. Mesh fixation with glue versus suture for chronic pain and recurrence in Lichtenstein inguinal hernioplasty. Cochrane Database Syst Rev. 2017;2(2):CD010814.

Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, Doorn HC, Heisterkamp J, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254-60.

Mcadory RS, Cobb WS, Carbonell AM. Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg. 2009;75(6):504-8.

Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF. Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg. 2012;204(2):144-50.

Parker SG, Halligan S, Blackburn S, Plumb AAO, Archer L, Mallett S, et al. What Exactly is Meant by "Loss of Domain" for Ventral Hernia? Systematic Review of Definitions. World J Surg. 2019;43(2):396-404.

Passot G, Villeneuve L, Sabbagh C, Renard Y, Regimbeau JM, Verhaeghe P, et al. Definition of giant ventral hernias: Development of standardization through a practice survey. Int J Surg. 2016;28:136-40.

Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407-14.

Trivellini G, Zanella G, Danelli PG, Pratolongo D, Ferri O. Surgical treatment of large eventrations. Study of a technic adapted to disorders of respiratory compliance. Chirurgie. 1984;110(2):116-22.

Lledó J, Torregrosa A, Ballester N, Carreño O, Carbonell F, Pastor PG, et al. Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia. 2017;21(2):233-43.

Tanaka EY, Yoo JH, Rodrigues AJ, Utiyama EM, Birolini D, Rasslan S. A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia. 2010;14(1):63-9.

Seretis F, Chrysikos D, Samolis A, Troupis T. Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes. In Vivo. 2021;35(4):1913-20.

Acevedo O, Elstner KE, Jacombs ASW, Read JW, Martins RT, Arduini F, et al. Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia. Surg Endosc. 2018;32(2):831-9.