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Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair

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Abstract

Purpose

Surgical repair of large hernia defects requires detailed pre-operative planning, particularly in cases with loss of domain. This situation often hampers mid-line reconstruction, even after component separation, when the size of the hernia is disproportional to the volume of the abdominal area. In this case, other strategies may be needed to place the viscera back into the abdominal cavity after reducing the hernia sac. The administration of botulinum toxin prior to the surgical procedure has been indicated as an adjunct for more complex cases. This results in stretching of the lateral musculature of the abdomen, allowing midline approximation. In addition, the application of botulinum toxin alone has been investigated as a means of downstaging in the management of ventral hernias, thereby precluding component separation and enabling primary closure of the midline by placement of mesh within the retromuscular space using the Rives Stoppa technique.

Methods

Systematic review of the literature for observational studies involving patients undergoing pre-operative application of botulinum toxin for ventral hernia repair was conducted according to the PRISMA guidelines.

Results

Advance of the lateral musculature of the abdomen by an average of 4.11 cm with low heterogeneity, as well as low rates of surgical site infection (SSI), surgical site occurrences (SSO) and recurrence, was shown.

Conclusion

Pre-operative application of botulinum toxin for ventral hernia repair promoted an increase in the length of the lateral musculature of the abdomen which can help improve the outcomes of morbidity and recurrence.

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Data Availability

The data that support the findings of this study are openly available in the references.

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Authors and Affiliations

  1. Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil

    E. R. M. Dias, G. Z. Rondini, P. H. F. Amaral, J. Z. Macret, J. P. V. Carvalho, L. G. A. Pivetta, C. A. Malheiros & S. Roll

  2. Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil

    E. R. M. Dias, P. H. F. Amaral, J. Z. Macret, J. P. V. Carvalho, L. G. A. Pivetta & S. Roll

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Contributions

DERM is the main author and contributed to search literature, data extraction, software, and formal analysis. RGZ contributed to search literature and data extraction. Amaral PH performed editing and validation. MJZ, CJCP and PLGA contributed to editing and methodology. MCA performed editing and supervision. RS contributed to editing, supervision and project administration and is the third reviewer.

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Correspondence to E. R. M. Dias.

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The present study was a systematic literature review in which no research involving humans was undertaken, and no permit from the local Research Ethics Committee for Research in Humans was required.

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Dias, E.R.M., Rondini, G.Z., Amaral, P.H.F. et al. Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair. Hernia 27, 807–818 (2023). https://doi.org/10.1007/s10029-023-02816-w

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