K E Elstner1,2, A S W Jacombs3, J W Read4,5, O Rodriguez2, M Edye1,6, P H Cosman1,2, A N Dardano7, A Zea2, T Boesel1, D J Mikami8, C Craft1, N Ibrahim9,10,11. 1. Macquarie University Hospital, Technology Place, Macquarie, Australia. 2. Hernia Institute Australia, Edgecliff, Australia. 3. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 4. Castlereagh Imaging, St Leonards, Australia. 5. Macquarie Medical Imaging, Macquarie University Hospital, Technology Place, Macquarie, Australia. 6. Faculty of Medicine, Western Sydney University, Sydney, Australia. 7. Boca Raton Regional Hospital, Boca Raton, FL, USA. 8. Ohio State University Wexner Medical Centre, Columbus, OH, USA. 9. Macquarie University Hospital, Technology Place, Macquarie, Australia. dri@zip.com.au. 10. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. dri@zip.com.au. 11. Hernia Institute Australia, Edgecliff, Australia. dri@zip.com.au.
Abstract
PURPOSE: The operative management of complex ventral hernia poses a formidable challenge, despite recent advances in surgical techniques. Recurrence rates after complex ventral hernia repair remain high, and increase with each failed attempt. This study examines the effect of pre-operative abdominal wall chemical component relaxation using Botulinum Toxin A (BTA) to induce temporary flaccid paralysis in order to facilitate laparoscopic repair of large complex ventral hernia. METHODS: This is a prospective evaluation of 27 patients from January 2013 to August 2015 who underwent ultrasound guided BTA injections to the lateral abdominal wall muscles prior to elective complex ventral hernia repair. Non-contrast serial CT imaging was obtained pre- and post-BTA injection to measure change in fascial defect size and abdominal wall muscle thickness and length. Fascial defects were closed and hernias repaired using laparoscopic or laparoscopic-assisted intra-peritoneal onlay mesh (IPOM) techniques. RESULTS: 27 patients received pre-operative BTA injections which were well tolerated with no complications. Comparison of pre-BTA and post-BTA CT imaging demonstrated a significant increase in mean length of the lateral abdominal wall from 15.7 cm pre-BTA to 19.9 cm post-BTA (p < 0.0001), with mean unstretched length gain of 4.2 cm/side (range 0-11.7 cm/side). All hernias were surgically reduced and repaired with mesh, with no early recurrences. CONCLUSION: Pre-operative administration of BTA is a safe and effective technique in the pre-operative preparation of patients undergoing elective complex ventral hernia repair. This technique lengthens and relaxes the laterally retracted abdominal muscles and enables laparoscopic closure of large complex ventral hernia.
PURPOSE: The operative management of complex ventral hernia poses a formidable challenge, despite recent advances in surgical techniques. Recurrence rates after complex ventral hernia repair remain high, and increase with each failed attempt. This study examines the effect of pre-operative abdominal wall chemical component relaxation using Botulinum Toxin A (BTA) to induce temporary flaccid paralysis in order to facilitate laparoscopic repair of large complex ventral hernia. METHODS: This is a prospective evaluation of 27 patients from January 2013 to August 2015 who underwent ultrasound guided BTA injections to the lateral abdominal wall muscles prior to elective complex ventral hernia repair. Non-contrast serial CT imaging was obtained pre- and post-BTA injection to measure change in fascial defect size and abdominal wall muscle thickness and length. Fascial defects were closed and hernias repaired using laparoscopic or laparoscopic-assisted intra-peritoneal onlay mesh (IPOM) techniques. RESULTS: 27 patients received pre-operative BTA injections which were well tolerated with no complications. Comparison of pre-BTA and post-BTA CT imaging demonstrated a significant increase in mean length of the lateral abdominal wall from 15.7 cm pre-BTA to 19.9 cm post-BTA (p < 0.0001), with mean unstretched length gain of 4.2 cm/side (range 0-11.7 cm/side). All hernias were surgically reduced and repaired with mesh, with no early recurrences. CONCLUSION: Pre-operative administration of BTA is a safe and effective technique in the pre-operative preparation of patients undergoing elective complex ventral hernia repair. This technique lengthens and relaxes the laterally retracted abdominal muscles and enables laparoscopic closure of large complex ventral hernia.
Authors: E B Deerenberg; L Timmermans; D P Hogerzeil; J C Slieker; P H C Eilers; J Jeekel; J F Lange Journal: Hernia Date: 2014-11-08 Impact factor: 4.739
Authors: K Itatsu; Y Yokoyama; G Sugawara; H Kubota; Y Tojima; Y Kurumiya; H Kono; H Yamamoto; M Ando; M Nagino Journal: Br J Surg Date: 2014-08-14 Impact factor: 6.939
Authors: N J Slater; A Montgomery; F Berrevoet; A M Carbonell; A Chang; M Franklin; K W Kercher; B J Lammers; E Parra-Davilla; S Roll; S Towfigh; E van Geffen; J Conze; H van Goor Journal: Hernia Date: 2013-10-23 Impact factor: 4.739
Authors: Faisal Farooque; Anita S W Jacombs; Emmanouel Roussos; John W Read; Anthony N Dardano; Michael Edye; Nabeel Ibrahim Journal: ANZ J Surg Date: 2015-08-05 Impact factor: 1.872
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G S Ferzli; R H Fortelny; F Köckerling; J Kukleta; K LeBlanc; D Lomanto; M C Misra; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2014-02 Impact factor: 4.584
Authors: Omar Rodriguez-Acevedo; Kristen E Elstner; Anita S W Jacombs; John W Read; Rodrigo Tomazini Martins; Fernando Arduini; Michael Wehrhahm; Colette Craft; Peter H Cosman; Anthony N Dardano; Nabeel Ibrahim Journal: Surg Endosc Date: 2017-07-21 Impact factor: 4.584
Authors: K E Elstner; J W Read; J Saunders; P H Cosman; O Rodriguez-Acevedo; A S W Jacombs; R T Martins; N Ibrahim Journal: Hernia Date: 2019-04-04 Impact factor: 4.739
Authors: Kristen E Elstner; John W Read; Omar Rodriguez-Acevedo; Peter H Cosman; Anthony N Dardano; Anita S W Jacombs; Michael Edye; Aaron Zea; Tillman Boesel; Dean J Mikami; Nabeel Ibrahim Journal: Surg Endosc Date: 2016-06-28 Impact factor: 4.584
Authors: Kristen E Elstner; John W Read; Anita S W Jacombs; Rodrigo Tomazini Martins; Fernando Arduini; Peter H Cosman; Omar Rodriguez-Acevedo; Anthony N Dardano; Alex Karatassas; Nabeel Ibrahim Journal: Surg Endosc Date: 2017-12-20 Impact factor: 4.584
Authors: Austin P Seaman; Kathryn A Schlosser; Daniel Eiferman; Vimal Narula; Benjamin K Poulose; Jeffrey E Janis Journal: J Gastrointest Surg Date: 2022-01-10 Impact factor: 3.267
Authors: Kristen E Elstner; John W Read; Omar Rodriguez-Acevedo; Kevin Ho-Shon; John Magnussen; Nabeel Ibrahim Journal: Surg Endosc Date: 2016-08-29 Impact factor: 4.584
Authors: Lucas Torres Oliveira; Felipe Futema Essu; Gustavo Heluani Antunes de Mesquita; Yuri Justi Jardim; Leandro Ryuchi Iuamoto; Fábio Yuji Suguita; Diego Ramos Martines; Fernanda Nii; Daniel Reis Waisberg; Alberto Meyer; Wellington Andraus; Luiz Augusto Carneiro D'Albuquerque Journal: Int J Surg Case Rep Date: 2017-10-12