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Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A

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Abstract

Purpose

The operative management of complex ventral hernia poses a formidable challenge, despite recent advances in surgical techniques. Recurrence rates after complex ventral hernia repair remain high, and increase with each failed attempt. This study examines the effect of pre-operative abdominal wall chemical component relaxation using Botulinum Toxin A (BTA) to induce temporary flaccid paralysis in order to facilitate laparoscopic repair of large complex ventral hernia.

Methods

This is a prospective evaluation of 27 patients from January 2013 to August 2015 who underwent ultrasound guided BTA injections to the lateral abdominal wall muscles prior to elective complex ventral hernia repair. Non-contrast serial CT imaging was obtained pre- and post-BTA injection to measure change in fascial defect size and abdominal wall muscle thickness and length. Fascial defects were closed and hernias repaired using laparoscopic or laparoscopic-assisted intra-peritoneal onlay mesh (IPOM) techniques.

Results

27 patients received pre-operative BTA injections which were well tolerated with no complications. Comparison of pre-BTA and post-BTA CT imaging demonstrated a significant increase in mean length of the lateral abdominal wall from 15.7 cm pre-BTA to 19.9 cm post-BTA (p < 0.0001), with mean unstretched length gain of 4.2 cm/side (range 0–11.7 cm/side). All hernias were surgically reduced and repaired with mesh, with no early recurrences.

Conclusion

Pre-operative administration of BTA is a safe and effective technique in the pre-operative preparation of patients undergoing elective complex ventral hernia repair. This technique lengthens and relaxes the laterally retracted abdominal muscles and enables laparoscopic closure of large complex ventral hernia.

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Author information

Authors and Affiliations

  1. Macquarie University Hospital, Technology Place, Macquarie, Australia

    K. E. Elstner, M. Edye, P. H. Cosman, T. Boesel, C. Craft & N. Ibrahim

  2. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

    A. S. W. Jacombs & N. Ibrahim

  3. Castlereagh Imaging, St Leonards, Australia

    J. W. Read

  4. Boca Raton Regional Hospital, Boca Raton, FL, USA

    A. N. Dardano

  5. Faculty of Medicine, Western Sydney University, Sydney, Australia

    M. Edye

  6. Hernia Institute Australia, Edgecliff, Australia

    K. E. Elstner, O. Rodriguez, P. H. Cosman, A. Zea & N. Ibrahim

  7. Ohio State University Wexner Medical Centre, Columbus, OH, USA

    D. J. Mikami

  8. Macquarie Medical Imaging, Macquarie University Hospital, Technology Place, Macquarie, Australia

    J. W. Read

Authors
  1. K. E. Elstner
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  2. A. S. W. Jacombs
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  3. J. W. Read
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  4. O. Rodriguez
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  5. M. Edye
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  6. P. H. Cosman
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  7. A. N. Dardano
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  8. A. Zea
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  9. T. Boesel
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  10. D. J. Mikami
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  11. C. Craft
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  12. N. Ibrahim
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Corresponding author

Correspondence to N. Ibrahim.

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Conflict of interest

KE, AJ, OR, ME, PC, AZ, TB, DM, CC, NI, declare no conflict of interest. JR declares conflict of interest related to the submitted work as he receives financial remuneration from Medicare as a radiologist. AD declares conflict of interest not directly related to the submitted work in the form of Honorarium from biomedical companies Cook, Synthes, and KCI.

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Elstner, K.E., Jacombs, A.S.W., Read, J.W. et al. Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A . Hernia 20, 209–219 (2016). https://doi.org/10.1007/s10029-016-1478-6

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  • DOI: https://doi.org/10.1007/s10029-016-1478-6

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