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Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair

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Abstract

In the past, various techniques had been described to repair large complex ventral hernias. Laparoscopic technique of components separation showed low complication rates and better overall outcome. Recently, Botulinum Toxin A (BTA) has shown benefit in achieving tension-free repair. We describe here our multimodal technique combining BTA injection, laparoscopic anterior components separation (LACS) and open mesh repair. Ten consecutive cases performed over 3 years were studied. A standardised technique was used with a reasonably short learning curve. Patients who generally fit for general anaesthesia were offered surgery after detailed preoperative imaging work up and informed consent. Demographic details, preoperative risk stratification, intraoperative and postoperative outcomes were recorded and analysed. A structured step by step management strategy was adopted. Total ten (n = 10) cases with median age of 42.5 years (range 28–76 years), male to female ratio of 8:2 and median BMI of 32.6 were included. Three patients had pre-existing stomas. Median diameter of hernial defect was 10 cm, IQR 4.8 cm and range of 6–20 cm. No intraoperative or immediate complications were observed. Median hospital stay was 6 days. Two seromas (20%) and two return to theatre (20%) were observed. One recurrence (10%) was observed after median follow-up of 32 months. No 90-day mortality was recorded. Multimodal technique of BTA injection, LACS and midline mesh repair is a reproducible, safe and effective option to repair large complex ventral hernias.

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Data availability

It is confirmed that data used in this study will be available on demand if needed and will be maintained for at least three years as per international standards by the authors.

Abbreviations

CST:

Components separation technique

TAR:

Transverse abdominal release

LCST:

Laparoscopic components separation technique

LCS:

Laparoscopic components separation

LACS:

Laparoscopic anterior components separation

BTA:

Botulinum Toxin A

ASA:

American Society of Anaesthesiology

BMI:

Body mass index

EHS:

European Hernia Society

HDU:

High dependency unit

COPD:

Chronic obstructive pulmonary disease

ITU:

Intensive treatment unit

PDS:

Polydioxanone suture

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Authors and Affiliations

  1. General & Colorectal Surgery Department, Luton & Dunstable University Hospital NHS Trust, Luton, Bedfordshire, UK

    Khawar S. Hashmi, Yagazie Zina Udeaja, Jamasp Dastur & Partha Das

  2. Department of Interventional Radiology, Luton & Dunstable University Hospital NHS Trust, Luton, Bedfordshire, UK

    Simon Allen

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  1. Khawar S. Hashmi
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  2. Yagazie Zina Udeaja
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Correspondence to Khawar S. Hashmi.

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Compliance with Ethical Standards

As this is an observational study of patients who underwent the repair abdominal wall hernias hence no formal ethical approval was needed.

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Patients were consented before surgery that their data and photographs can be used for research and publication purposes. A written consent had been obtained.

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Hashmi, K.S., Udeaja, Y.Z., Dastur, J. et al. Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01822-6

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