Kristen E Elstner1,2, John W Read3,4, Omar Rodriguez-Acevedo2, Peter H Cosman1,2,5, Anthony N Dardano6, Anita S W Jacombs7, Michael Edye1,5, Aaron Zea2, Tillman Boesel1, Dean J Mikami8, Nabeel Ibrahim9,10,11. 1. Macquarie University Hospital, Technology Place, Macquarie, NSW, Australia. 2. Hernia Institute Australia, Edgecliff, NSW, Australia. 3. Castlereagh Imaging, St Leonards, NSW, Australia. 4. Macquarie Medical Imaging, Macquarie University Hospital, Technology Place, Macquarie, NSW, Australia. 5. Western Sydney University, Penrith, NSW, Australia. 6. Boca Raton Regional Hospital, Boca Raton, FL, USA. 7. Faculty of Medicine and Health Sciences, Macquarie University, Macquarie, NSW, Australia. 8. Ohio State University Wexner Medical Centre, Columbus, OH, USA. 9. Macquarie University Hospital, Technology Place, Macquarie, NSW, Australia. Dri@zip.com.au. 10. Hernia Institute Australia, Edgecliff, NSW, Australia. Dri@zip.com.au. 11. Faculty of Medicine and Health Sciences, Macquarie University, Macquarie, NSW, Australia. Dri@zip.com.au.
Abstract
BACKGROUND: Repair of complex ventral hernia can be very challenging for surgeons. Closure of large defects can have serious pathophysiological consequences. Botulinum toxin A (BTA) has recently been described to provide flaccid paralysis to abdominal muscles prior to surgery, facilitating closure and repair. METHODS: This was a prospective observational study of 32 patients who underwent ultrasound-guided injections of BTA to the lateral abdominal wall muscles prior to elective repair of complex ventral hernia between January 2013 and December 2015. Serial non-contrast abdominal CT imaging was performed to measure changes in fascial defect size, abdominal wall muscle length and thickness. All hernias were repaired laparoscopically or laparoscopic-assisted with placement of intra-peritoneal mesh. RESULTS: Thirty-two patients received BTA injections which were well tolerated with no complications. A comparison of baseline (preBTA) CT imaging with postBTA imaging demonstrated an increase in mean baseline abdominal wall length from 16.4 to 20.4 cm per side (p < 0.0001), which translates to a gain in mean transverse length of the unstretched anterolateral abdominal wall muscles of 4.0 cm/side (range 0-11.7 cm/side). Fascial closure was achieved in all cases, with no instances of raised intra-abdominal pressures or its sequelae, and there have been no hernia recurrences to date. CONCLUSIONS: Preoperative BTA injection to the muscles of the anterolateral abdominal wall is a safe and effective technique for the preoperative preparation of patients prior to laparoscopic mesh repair of complex ventral hernia. This technique elongates and thins the contracted and retracted musculature, enabling closure of large defects.
BACKGROUND: Repair of complex ventral hernia can be very challenging for surgeons. Closure of large defects can have serious pathophysiological consequences. Botulinum toxin A (BTA) has recently been described to provide flaccid paralysis to abdominal muscles prior to surgery, facilitating closure and repair. METHODS: This was a prospective observational study of 32 patients who underwent ultrasound-guided injections of BTA to the lateral abdominal wall muscles prior to elective repair of complex ventral hernia between January 2013 and December 2015. Serial non-contrast abdominal CT imaging was performed to measure changes in fascial defect size, abdominal wall muscle length and thickness. All hernias were repaired laparoscopically or laparoscopic-assisted with placement of intra-peritoneal mesh. RESULTS: Thirty-two patients received BTA injections which were well tolerated with no complications. A comparison of baseline (preBTA) CT imaging with postBTA imaging demonstrated an increase in mean baseline abdominal wall length from 16.4 to 20.4 cm per side (p < 0.0001), which translates to a gain in mean transverse length of the unstretched anterolateral abdominal wall muscles of 4.0 cm/side (range 0-11.7 cm/side). Fascial closure was achieved in all cases, with no instances of raised intra-abdominal pressures or its sequelae, and there have been no hernia recurrences to date. CONCLUSIONS: Preoperative BTA injection to the muscles of the anterolateral abdominal wall is a safe and effective technique for the preoperative preparation of patients prior to laparoscopic mesh repair of complex ventral hernia. This technique elongates and thins the contracted and retracted musculature, enabling closure of large defects.
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
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Authors: K E Elstner; A S W Jacombs; J W Read; O Rodriguez; M Edye; P H Cosman; A N Dardano; A Zea; T Boesel; D J Mikami; C Craft; N Ibrahim Journal: Hernia Date: 2016-03-07 Impact factor: 4.739
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Authors: Y Yurtkap; M M J van Rooijen; S Roels; J M L Bosmans; O Uyttebroek; J F Lange; F Berrevoet Journal: Hernia Date: 2020-06-03 Impact factor: 4.739
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; 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: 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