Peculiarities of the botulinum toxin type A injection technique and its effectiveness in the surgical treatment of large ventral hernias
DOI:
https://doi.org/10.30978/GS-2024-3-14Keywords:
incisional hernia, ventral hernia, hernioplasty, botulinum toxinAbstract
Ventral hernias (VH) continue to be one of the most common surgical pathologies in planned and emergency surgery. Surgical treatment of large VH (≥10 cm) requires the use of traumatic surgical techniques in order to align the edges of the hernia defect and restore the integrity of the anterior abdominal wall.
Objective — to assess the effectiveness of the botulinum toxin type A (BTA) injections and to study the peculiarities of their administration into the muscles of the anterior abdominal wall in patients with large VH in the preoperative period.
Materials and methods. A prospective cohort study included 66 patients with large VH, primary (PVH), and incisional (IH). From June 2017 to August 2024, all patients underwent treatment and received injections of 100 units of BTA into the anterior abdominal wall muscles in the preoperative period. The patients’ average age was 58.98±9.48. There were 23 men (34.8%) and 43 women (65.2%). Before BTA, the average width of the hernial defect in PVH patients was 12.29±1.93 cm, whereas IH was 13.46±2.06 cm. All patients underwent surgical intervention for their hernias 4—5 weeks after the injection of BTA.
Results. No complications were detected throughout the BTA administration or the 4—5 weeks of observation before the surgical hernia repair. After injection, the length of the anterior abdominal wall muscles increased by an average of 1.7 cm (min 0.1 cm, max 4.01 cm) on each side. Patients with PVH had an average hernial defect width reduction of 4.17±0.68 cm, whereas those with IH had an average reduction of 5.14±0.75 cm (p <0.001). After BTA administration, the volume ratio of the hernia sac to the abdominal cavity decreased from 4.97±3.55% to 3.70±2.77% in patients with PVH (p=0.008) and from 5.59±3.71% to 4.21±2.88% in patients with IH (p=0.008).
Conclusions. The administration of 100 units of botulinum toxin type A in the preoperative period consistenly increases the length of the abdominal wall muscles, reduces the width of the hernial defect, and enhances the possibilities of further surgical treatment of large VH using laparoscopic technologies.
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