A Tashkandi1,2, J Bueno-Lledó3, J Durtette-Guzylack4, A Cayeux4, R Bukhari5, R Rhaeim4, J M Malinovski6, R Kianmanesh4, Y Renard4. 1. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France. tashkandi@outlook.com. 2. Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia. tashkandi@outlook.com. 3. Unit of Abdominal Wall Surgery. Department of Digestive Surgery. Hospital, Universitari I Politecnic "La Fe". University of Valencia, Valencia, Spain. 4. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France. 5. King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. 6. Department of Anesthesia Robert, Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
Abstract
INTRODUCTION: Incisional hernia with loss of domain (IHLD) remains a surgical challenge. Its management requires complex approaches including specific preoperative and intra-operative techniques. This study focuses on the interest of adding preoperative botulinum toxin A (BTA) injection to preoperative progressive pneumoperitoneum (PPP), compared to PPP alone. MATERIAL: Patients between January 2015 and March 2020 with IHLD who underwent pre-operative preparation were included. Their baseline characteristics were retrospectively analyzed, along with the characteristics of their incisional hernia before and after preparation including CT-scan volumetry. Intra-operative data, early post-operative outcomes, surgical site occurrences (SSOs) including surgical site infection (SSI) were recorded. RESULTS: Four hundred and fifty (450) patients with incisional hernia were operated, including 41 patients (9.1%) with IHLD, 13 of which had both BTA and PPP, while 28 had PPP only. Both groups were comparable in term of patients and IHLD characteristics. Median increase in the volume of the abdominal cavity (VAbC) was + 55% for the entire population (+ 58.3% for the BTA-PPP group, p < 0.0001 and + 52.8% for the PPP-alone group, p < 0.0001) although the increase in volume was not different between the two groups (p = 0.99). Complete fascial closure was achieved in all patients. SSOs were more frequent in the PPP-alone group than in the BTA-PPP group (17 (60.7%) versus 3 (23.1%) patients, respectively, p = 0.043). CONCLUSION: BTA and PPP are both useful in pre-operative preparation for IHLD. Combining both significantly increases the volume of abdominal cavity but associating BTA to PPP does not add any volumetric benefit but may decrease the post-operative SSO rate.
INTRODUCTION: Incisional hernia with loss of domain (IHLD) remains a surgical challenge. Its management requires complex approaches including specific preoperative and intra-operative techniques. This study focuses on the interest of adding preoperative botulinum toxin A (BTA) injection to preoperative progressive pneumoperitoneum (PPP), compared to PPP alone. MATERIAL: Patients between January 2015 and March 2020 with IHLD who underwent pre-operative preparation were included. Their baseline characteristics were retrospectively analyzed, along with the characteristics of their incisional hernia before and after preparation including CT-scan volumetry. Intra-operative data, early post-operative outcomes, surgical site occurrences (SSOs) including surgical site infection (SSI) were recorded. RESULTS: Four hundred and fifty (450) patients with incisional hernia were operated, including 41 patients (9.1%) with IHLD, 13 of which had both BTA and PPP, while 28 had PPP only. Both groups were comparable in term of patients and IHLD characteristics. Median increase in the volume of the abdominal cavity (VAbC) was + 55% for the entire population (+ 58.3% for the BTA-PPP group, p < 0.0001 and + 52.8% for the PPP-alone group, p < 0.0001) although the increase in volume was not different between the two groups (p = 0.99). Complete fascial closure was achieved in all patients. SSOs were more frequent in the PPP-alone group than in the BTA-PPP group (17 (60.7%) versus 3 (23.1%) patients, respectively, p = 0.043). CONCLUSION: BTA and PPP are both useful in pre-operative preparation for IHLD. Combining both significantly increases the volume of abdominal cavity but associating BTA to PPP does not add any volumetric benefit but may decrease the post-operative SSO rate.
Authors: C Fink; P Baumann; M N Wente; P Knebel; T Bruckner; A Ulrich; J Werner; M W Büchler; M K Diener Journal: Br J Surg Date: 2013-11-26 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: David C Bosanquet; James Ansell; Tarig Abdelrahman; Julie Cornish; Rhiannon Harries; Amy Stimpson; Llion Davies; James C D Glasbey; Kathryn A Frewer; Natasha C Frewer; Daphne Russell; Ian Russell; Jared Torkington Journal: PLoS One Date: 2015-09-21 Impact factor: 3.240