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Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center

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Abstract

Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed (60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs.

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Data availability

The datasets used for the current study may be available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA

    Lucas Fair, Steven G. Leeds, Tanner Mathews, Marc A. Ward & Bola Aladegbami

  2. Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA

    Lucas Fair, Steven G. Leeds, Tanner Mathews, Marc A. Ward & Bola Aladegbami

  3. Texas A&M College of Medicine, Bryan, TX, USA

    Steven G. Leeds, Simon Esteva, Marc A. Ward & Bola Aladegbami

  4. Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA

    Lucas Fair, Syed Harris Bokhari & Gerald O. Ogola

Authors
  1. Lucas Fair
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  2. Steven G. Leeds
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  3. Syed Harris Bokhari
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  4. Simon Esteva
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  5. Tanner Mathews
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  6. Gerald O. Ogola
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  7. Marc A. Ward
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  8. Bola Aladegbami
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All authors listed above contributed to this manuscript and meet the requirements of appropriate authorship as defined by the International Committee of Medical Journal Editors (ICMJE).

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Correspondence to Lucas Fair.

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Fair, L., Leeds, S.G., Bokhari, S.H. et al. Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01802-w

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  • DOI: https://doi.org/10.1007/s13304-024-01802-w

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