P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN

Abstract Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

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Image-guided botulinum toxin injection in the lateral abdominal wall prior to abdominal wall reconstruction surgery: review of techniques and results

Skeletal Radiology ◽

10.1007/s00256-020-03533-6 ◽

2020 ◽

Vol 50 (1) ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Eva B. Deerenberg ◽

Sharbel A. Elhage ◽

Robert J. Raible ◽

Jenny M. Shao ◽

Vedra A. Augenstein ◽

...

Keyword(s):

Botulinum Toxin ◽

Abdominal Wall ◽

Botulinum Toxin Injection ◽

Abdominal Wall Reconstruction ◽

Lateral Abdominal Wall ◽

Reconstruction Surgery ◽

Image Guided

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Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

Surgical Innovation ◽

10.1177/1553350620914195 ◽

2020 ◽

pp. 155335062091419

Author(s):

Jorge Daes ◽

Joshua S. Winder ◽

Eric M. Pauli

Keyword(s):

Abdominal Wall ◽

Lateral Displacement ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Transversus Abdominis ◽

Lateral Abdominal Wall ◽

Computed Tomography Images ◽

Fresh Cadaver ◽

Semilunar Line ◽

Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

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P015 ABDOMINAL WALL PREPARATION PRECEDING COMPLEX ABDOMINAL WALL RECONSTRUCTION (CAWR) - SINGLE CENTER INITIAL EXPERIENCES UTILIZING BOTULINUM TOXIN A (BTA) ACCOMPANIED IN SELECTED PATIENTS BY PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM (PPP)

British Journal of Surgery ◽

10.1093/bjs/znab395.014 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Henrik Husu ◽

Sanna Valle ◽

Tom Scheinin ◽

Jaana Vironen

Keyword(s):

Abdominal Wall ◽

Botulinum Toxin A ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Fascial Closure ◽

Abdominal Wall Defects ◽

Closure Rate ◽

Loss Of Domain ◽

Lateral Abdominal Wall ◽

Preoperative Progressive Pneumoperitoneum

Abstract Aim Complex ventral hernia (CVH) treatment due to large abdominal wall defects or loss of domain is challenging. BTA-injection in lateral abdominal wall causing flaccid paralysis and elongation, so called chemical component separation (CCS), might facilitate closure of large fascial defects. Combining preoperative progressive pneumoperitoneum might help restore abdominal content in severe loss of domain situations. We studied the results after CAWR following abdominal wall preparation with BTA and possible PPP. Primary aim was to report fascial defect closure rate without need for surgical component separation. Material and Methods All electively operated patients to date that were treated preoperatively with BTA, including all patients treated with PPP. Results Hospital index patient received preoperative BTA in January 2018. Since then, altogether 42 patients underwent CCS prior to CAWR. Average patient suffered from obesity (mean BMI 31), 30% had diabetes, and a third were active smokers. Mean hernia defect area exceeded 200 cm2. All operations were mesh repairs. Surgical approach was mostly (88%) open retromuscular. Abdominal wall reconstruction via fascial closure was achieved in 93% of cases with only 21% needing surgical component separation. Preoperative morbidity was common in patients undergoing PPP. Around 40% of all patients had postoperative complications, half of which were surgical complications. One patient died of a yet unknown cause on the third postoperative day. There were no recurrences within median 15 months follow-up. Conclusions Restoring abdominal wall continuity without frequent need for surgical component separation seems likely in CVH following CCS.

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Use of Botulinum Toxin A Combined with Component Separation in Massive Abdominal Wall Reconstruction with Enterocutaneous Fistulas

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.08.394 ◽

2018 ◽

Vol 227 (4) ◽

pp. e144-e145

Author(s):

Kathryn Schlosser ◽

Javier Otero ◽

Michael R. Arnold ◽

Paul D. Colavita ◽

Brant T. Heniford

Keyword(s):

Botulinum Toxin ◽

Abdominal Wall ◽

Botulinum Toxin A ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Toxin A

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Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

Surgical Innovation ◽

10.1177/15533506211041477 ◽

2021 ◽

pp. 155335062110414

Author(s):

Dietmar Eucker ◽

Nadine Rüedi ◽

Clinton Luedtke ◽

Oliver Stern ◽

Henning Niebuhr ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Long Term Results ◽

Anatomical Reconstruction ◽

Time Saving ◽

Lateral Abdominal Wall ◽

Hernia Size ◽

Midline Closure

Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Methods Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. Results 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12–16) cm, the median gain in length on the lateral abdominal wall was 12 (10–15) cm. After median follow-up of 29 (12–54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Conclusion Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

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O50 ALTERATIONS IN THE ABDOMINAL WALL MUSCULATURE AFTER ENDOSCOPIC ANTERIOR AND OPEN POSTERIOR COMPONENT SEPARATION

British Journal of Surgery ◽

10.1093/bjs/znab396.049 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Erling Oma ◽

Jan Kim Christensen ◽

Jorge Daes ◽

Lars Nannestad Jorgensen

Keyword(s):

Abdominal Wall ◽

Case Series ◽

Muscle Thickness ◽

Component Separation ◽

Fascial Closure ◽

Lateral Abdominal Wall ◽

Transverse Abdominis ◽

Abdominal Wall Muscle ◽

Anterior Component Separation

Abstract Aim Effects of component separation (CS) on abdominal wall musculature have only been investigated in smaller case series. The study aimed to compare abdominal wall alterations following endoscopic anterior component separation (EACS) or transverse abdominis release (TAR). Material and Methods Computed tomography scans were evaluated in patients who underwent open ventral hernia repair with TAR or EACS. Lateral abdominal wall muscle thickness and displacement were compared with preoperative images after bilateral CS and the undivided side postoperatively after unilateral CS. Results In total, 105 patients were included. The mean defect width was 12.2 cm. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. Complete fascial closure was achieved in 103 (98%) patients. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74 cm (95% CI 2.29-3.19 cm) and 0.82 cm (0.07-1.57 cm) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% [5.8-15.6%]) and insignificantly decreased after TAR (mean decrease 2.6% [-4.8-9.5%]), mean reduction difference EACS versus TAR 0.22 cm (-0.01-0.46 cm). One (1%) patient developed an iatrogenic linea semilunaris hernia after EACS. The recurrence rate was 19% after mean 1.7 years follow-up. Conclusions The divided muscle was significantly more laterally displaced after EACS compared with TAR. The thickness of the lateral muscles was slightly decreased after EACS and unchanged after TAR.

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