Preoperative botulinum toxin A injection in complex abdominal wall reconstruction– a propensity-scored matched study - 12/08/21
, Jenny Meng Shao a, c , Sharbel Adib Elhage a , Robert Lopez d , Sullivan Armando Ayuso a , Vedra Abdomerovic Augenstein a , B. Todd Heniford a, ⁎ Abstract |
Introduction |
Fascial closure during complex abdominal wall reconstruction (AWR) improves recurrence and wound infection rates. To facilitate fascial closure in massive ventral hernias preoperative Botulinum Toxin A (BTA) injection can be used.
Methods |
2:1 propensity-scored matching of patients undergoing AWR with and without BTA was performed based on BMI, defect width, and loss of domain using CT-volumetric analysis.
Results |
145 patients without BTA and 75 with BTA were comparable on hernia size (240vs251cm2, p = 0.589) and hernia volume (1405vs1672cm3, p = 0.243). Patients with BTA had higher wound class (CDC≥3 37%vs13%, p < 0.001). Patients with BTA had a higher fascial closure rate (92%vs81%, p = 0.036), received more components separation (61%vs47%, p = 0.042), lower wound infection rate (12%vs26%,p = 0.019) and comparable recurrence rates (9%vs12%, p = 0.589). Recurrences occurred more often without complete fascial closure compared to patients with (33%vs7%, p < 0.001).
Conclusion |
In patients with massive ventral hernias and severe loss of domain, preoperative BTA-injection improves fascial closure rates during AWR.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Fascial closure during hernia repair is essential to reduce recurrence rates. |
• | Botulinum Toxin A (Botox®) is used in massive ventral hernias with loss of domain. |
• | Massive hernias with and without preoperative Botox® were closely matched. |
• | After Botox® injection, a higher rate of massive ventral hernias could be closed. |
• | Hernia recurrences occurred more often in patients without complete fascial closure. |
Keywords : Hernia, Complex abdominal wall reconstruction, Incisional, Ventral, Botulinum toxin a, Recurrence
Plan
Vol 222 - N° 3
P. 638-642 - septembre 2021 Retour au numéro
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