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Use of Botulinum Toxin Type A Before Abdominal Wall Hernia Reconstruction

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Abstract

Background

Abdominal wall hernia repair after open abdomen management represents a surgical challenge, particularly due to muscle tension and lateral retraction. This study was designed to propose the use of Botulinum Toxin Type A (BTA) before abdominal wall hernia repair.

Methods

A prospective study of patients with abdominal wall hernia after open abdomen management was undertaken between September 2007 and January 2009. Bilateral BTA application was performed under electromyographic guidance at the abdominal wall. Transverse abdominal wall defect measurement was practiced at weekly intervals: clinically, in the first two patients, and with CT scan in the following 10 patients. Surgical closure was scheduled if no further hernia defect reduction was noted. Patients were followed at monthly hospital visits.

Results

In the first two patients, a hernia defect reduction of 50 and 47.2%, respectively, was documented by the third week after BTA application, with no further reduction. In the 10 patients under CT scan hernia defect measurement, when comparing the initial mean transverse defect measure and at 4 weeks after BTA application (13.85 ± 1.49 cm vs. 8.6 ± 2.07 cm), an overall mean reduction of 5.25 ± 2.32 cm was observed (p < 0.001; 95% confidence interval, 3.59–6.91). Hernia repair was performed, with no recurrences at a mean follow-up of 9.08 months.

Conclusions

BTA application before abdominal wall hernia repair seems to be useful. The lateral muscles paralysis achieved and transverse hernia defect reduction allows a minimal tension closure. To our knowledge, this is the first report of BTA application before abdominal wall hernia reconstruction.

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References

  1. Cheng H, Rupprecht F, Jackson D et al (2007) Decision analysis model of incisional hernia after open abdominal surgery. Hernia 11:129–137

    Article  CAS  PubMed  Google Scholar 

  2. Jacobs DG, Pratt BL, Capizzi PJ (2002) Reconstruction of the massive posttraumatic abdominal wall hernia. Prob Gen Surg 19:73–83

    Article  Google Scholar 

  3. Rohrer TE, Beer K (2005) Background to Botulinum toxin. In: Carruthers A, Carruthers J (eds) Botulinum toxin. Elsevier Saunders, Philadelphia, pp 9–17

    Google Scholar 

  4. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526

    Article  CAS  PubMed  Google Scholar 

  5. Helton WS, Fisichella PM, Berger R et al (2005) Short-term outcomes with small intestine submucosa for ventral abdominal hernia. Arch Surg 140:549–560

    Article  PubMed  Google Scholar 

  6. Jacobsen WM, Petty PM, Bite U et al (1997) Massive abdominal wall hernia reconstruction with expanded external-internal oblique and transversalis musculofascia. Plast Reconstr Surg 100:326–335

    Article  CAS  PubMed  Google Scholar 

  7. Lindsey JT (2003) Abdominal wall partitioning (the accordion effect) for reconstruction of major defects: a retrospective review of 10 patients. Plast Reconstr Surg 112:477–485

    Article  PubMed  Google Scholar 

  8. Jernigan TW, Fabian TC, Croce MA et al (2003) Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 238:349–355

    PubMed  Google Scholar 

  9. Sleeman D, Sosa JL, Gonzalez A et al (1995) Reclosure of the open abdomen. J Am Coll Surg 180:200–204

    CAS  PubMed  Google Scholar 

  10. Shestak KC, Edington HJ, Johnson RR (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 105:731–738

    Article  CAS  PubMed  Google Scholar 

  11. Rohrich RJ, Lowe JB, Hackney FL et al (2000) An algorithm for abdominal wall reconstruction. Plast Reconstr Surg 105:202–216

    Article  CAS  PubMed  Google Scholar 

  12. Fabian TC, Croce MA, Pritchard FE et al (1994) Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 219:643–650

    Article  CAS  PubMed  Google Scholar 

  13. Mathes SJ, Steinwald PM, Foster RD et al (2000) Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg 232:586–596

    Article  CAS  PubMed  Google Scholar 

  14. Levine JP, Karp NS (2001) Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release. Plast Reconstr Surg 107:707–716

    Article  CAS  PubMed  Google Scholar 

  15. Lowe JB, Garza JR, Bowman JL et al (2000) Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg 105:720–729

    Article  CAS  PubMed  Google Scholar 

  16. DuBay DA, Choi W, Urbanchek MG et al (2007) Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg 245:140–146

    Article  PubMed  Google Scholar 

  17. Cakmak M, Caglayan F, Somuncu S et al (2006) Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study. J Pediatr Surg 41:821–825

    Article  PubMed  Google Scholar 

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Disclosure

There was no external financial support for the achievement of this study. There is no conflict of interest to report by the authors.

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Authors and Affiliations

  1. Department of General Surgery, Antiguo Hospital Civil de Guadalajara, Av. Circunvalación Dr. Atl No. 154. Col. Independencia, Guadalajara, Jalisco, 44340, México

    Tomas R. Ibarra-Hurtado, Carlos M. Nuño-Guzmán & Jorge E. Echeagaray-Herrera

  2. Department of Plastic and Reconstructive Surgery, Antiguo Hospital Civil de Guadalajara, Guadalajara, Jalisco, México

    Everardo Robles-Vélez

  3. Department of Rehabilitation Medicine, Antiguo Hospital Civil de Guadalajara, Guadalajara, Jalisco, México

    José de Jesús González-Jaime

Authors
  1. Tomas R. Ibarra-Hurtado
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  2. Carlos M. Nuño-Guzmán
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  3. Jorge E. Echeagaray-Herrera
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  4. Everardo Robles-Vélez
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  5. José de Jesús González-Jaime
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Corresponding author

Correspondence to Tomas R. Ibarra-Hurtado.

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Ibarra-Hurtado, T.R., Nuño-Guzmán, C.M., Echeagaray-Herrera, J.E. et al. Use of Botulinum Toxin Type A Before Abdominal Wall Hernia Reconstruction. World J Surg 33, 2553–2556 (2009). https://doi.org/10.1007/s00268-009-0203-3

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  • DOI: https://doi.org/10.1007/s00268-009-0203-3

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