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Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair

  • K. E. Elstner
  • J. W. Read
  • J. Saunders
  • P. H. Cosman
  • O. Rodriguez-Acevedo
  • A. S. W. Jacombs
  • R. T. Martins
  • N. IbrahimEmail author
Original Article



Repair of complex ventral hernia presents a significant challenge plagued by high morbidity and recurrence. Recent studies have demonstrated significant benefits achievable with preoperative Botulinum Toxin A (BTA) chemical component paralysis to the abdominal wall muscles, facilitating primary closure of complex ventral hernia defects. However, transversus abdominis is known to play an integral role in truncal stability, and its paralysis can result in unwanted physiological changes. This is the first study to report on selective administration of preoperative BTA to internal and external oblique muscles only, thus sparing transversus abdominis from paralysis.


This is a prospective observational study of 46 patients who underwent either selective two-layer or standard three-layer abdominal wall muscle BTA injection prior to elective laparoscopic ventral hernia repair. Serial abdominal CT imaging was performed to compare defect size and length of the lateral abdominal musculature.


46 patients received preoperative BTA injections (23 in each group). A comparison of gains achieved from chemical component paralysis demonstrated no statistically significant difference between the two groups. Fascial closure was achieved in all cases, with no post-operative sequelae of abdominal hypertension. There are no hernia recurrences to date.


Preoperative selective muscle chemical component paralysis is an effective technique to counteract the chronic muscle retraction observed in large ventral hernias. Transversus abdominis plays a significant role in truncal and spinal stability, and sparing it from paralysis preserves an important component of abdominal wall physiology and does not detract from the ability to primarily close complex defects.


Complex ventral hernia Incisional hernia Botulinum toxin A Chemical component paralysis 



A/Prof Michael Talbot, Dr William Mackie, Dr Alexander Bay, and Isabelle Ibrahim are acknowledged


There are no sources of funding to disclose.

Compliance with ethical standards

Conflicts of interest

All authors (KE, JS, PC, OR, AJ, RTM, and NI) declare no conflicts of interest, with the exception of JR, who declares conflict of interest related to the submitted work as he receives financial remuneration from Medicare as a radiologist.

Ethical approval

Approval from the institutional review board was not required for this study.

Human and animal rights

The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Macquarie University Hospital, Technology PlaceMacquarieAustralia
  2. 2.Hernia Institute AustraliaEdgecliffAustralia
  3. 3.Macquarie Medical ImagingMacquarie University Hospital, Technology PlaceMacquarieAustralia
  4. 4.University of Notre DameSydneyAustralia

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