Botulinum Toxin A Facilitated Laparoscopic Repair of Complex Ventral Hernia

Background: Complex ventral hernia repair can be challenging despite the recent advances in surgical techniques. Here, we aimed to examine the effectiveness of preoperative combined use of botulinum toxin A (BTA) and preoperative progressive pneumoperitoneum (PPP) for surgical preparation of patients with complex ventral hernia.Methods: In this prospective, observational study, we included 22 patients with complex ventral hernia between January 2018 and May 2021. All patients were treated with BTA injections into the lateral abdominal muscles and PPP before hernia repair. The lengths of abdominal wall muscles, the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after BTA and PPP using abdominal CT scan. All Hernias were repaired using laparoscopic intra-peritoneal onlay mesh (IPOM) or laparoscopic-open-laparoscopic (LOL) techniques.Results: Imaging showed a significant increase in the mean lateral abdominal muscle length from 13.1 to 17.2 cm/side (p < 0.01). Before and after BTA and PPP, the mean VIH was 894 cc and 1209 cc (P < 0.01), and the mean VAC was 6,692 cc and 9,183 cc (P < 0.01). The VAC increased by 2,491 cc (P < 0.01) and was greater than the mean VIH before PPP. An average reduction of 0.9% of the VIH/VAC ratio after BTA and PPP was obtained (p > 0.05). All hernias were surgically reduced with mesh, hernia recurrence occurred in only two patients.Conclusions: The preoperative combined use of PPP and BTA increased the abdominal volume, lengthened the laterally retracted abdominal muscles, and facilitated laparoscopic closure of large complex ventral hernia.

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Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair

Hernia ◽

10.1007/s10029-019-01939-3 ◽

2019 ◽

Vol 24 (2) ◽

pp. 287-293 ◽

Cited By ~ 5

Author(s):

K. E. Elstner ◽

J. W. Read ◽

J. Saunders ◽

P. H. Cosman ◽

O. Rodriguez-Acevedo ◽

...

Keyword(s):

Botulinum Toxin ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Botulinum Toxin A ◽

Toxin A ◽

Complex Ventral Hernia

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Evaluation of Changes in Depression Levels of Bruxism Patients Treated With Botulinum Toxin-A

Journal of Advanced Oral Research ◽

10.1177/23202068211006554 ◽

2021 ◽

pp. 232020682110065

Author(s):

Deniz Erdil ◽

Nilsun Bagis ◽

Hakan Eren ◽

Melike Camgoz ◽

Kaan Orhan

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Age Groups ◽

Treatment Method ◽

Definitive Treatment ◽

Toxin A ◽

Physiological Factors ◽

Before And After ◽

The Mean ◽

Post Hoc

Aim: Bruxism is defined as the involuntary recurrent masticatory muscle activity characterized by gnashing, grinding, clenching of teeth, and/or pushing the mandible. Factors creating its etiology are peripheral (morphological) or central (physiopathological and physiological), and exogenous. Recently, among physiological factors, depression and bruxism were considered to be related. A definitive treatment method does not exist for bruxism; however, botulinum toxin-A (BT-A) application is an up-to-date and effective way of treatment. The present study is aimed to evaluate the levels of depression in bruxism patients treated with BT-A application. Materials and Methods: A total of 25 individuals (23 females and 2 males) who were diagnosed as bruxism patients were included in the study. 25 U of BT-A for each masseter muscle was injected into the patients. Patients were prospectively observed for a possible change in depression levels by using Beck’s Depression Inventory. The inventory was implemented before and six months after the BT-A application. Depression levels before and six months after the injection were compared. A paired t-test was used to compare “before” and “after” treatment values. One-way analysis of variance and post-hoc Tukey tests were used to evaluate the change in Beck’s Depression Inventory scores according to age groups. Results: The mean total score was 7.80 ± 8.10 before the treatment and 7.16 ± 6.52 six months after the treatment. The decrease in the mean score was not statistically significant ( P > .05). Conclusion: In conclusion, despite the decrease in the mean Beck’s Depression Inventory scores, a statistically significant decrease in the depression levels of patients was not observed.

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Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair

ANZ Journal of Surgery ◽

10.1111/ans.13258 ◽

2015 ◽

Vol 86 (1-2) ◽

pp. 79-83 ◽

Cited By ~ 36

Author(s):

Faisal Farooque ◽

Anita S. W. Jacombs ◽

Emmanouel Roussos ◽

John W. Read ◽

Anthony N. Dardano ◽

...

Keyword(s):

Botulinum Toxin ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Botulinum Toxin A ◽

Abdominal Muscle ◽

Toxin A ◽

Incisional Ventral Hernia

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Preoperative chemical component relaxation using Botulinum toxin A: enabling laparoscopic repair of complex ventral hernia

Surgical Endoscopy ◽

10.1007/s00464-016-5030-7 ◽

2016 ◽

Vol 31 (2) ◽

pp. 761-768 ◽

Cited By ~ 23

Author(s):

Kristen E. Elstner ◽

John W. Read ◽

Omar Rodriguez-Acevedo ◽

Peter H. Cosman ◽

Anthony N. Dardano ◽

...

Keyword(s):

Botulinum Toxin ◽

Ventral Hernia ◽

Laparoscopic Repair ◽

Botulinum Toxin A ◽

Chemical Component ◽

Toxin A ◽

Complex Ventral Hernia

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P008 SYNCHRONOUS SURGICAL TREATMENT OF MORBID OBESITY AND COMPLEX VENTRAL HERNIA AFTER PROGRESSIVE PNEUMOPERITONEUM AND BOTULINUM TOXIN A INJECTION

British Journal of Surgery ◽

10.1093/bjs/znab395.007 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Camillo Leonardo Bertoglio ◽

Lorenzo Morini ◽

Gisella Barone ◽

Marianna Maspero ◽

Bruno Alampi ◽

...

Keyword(s):

Bariatric Surgery ◽

Botulinum Toxin ◽

Hernia Repair ◽

Abdominal Wall ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Botulinum Toxin A ◽

Morbidly Obese ◽

Obese Patients ◽

Toxin A

Abstract Aim the worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing: synchronous bariatric and abdominal wall surgery versus delayed abdominal wall surgery. We report an innovative tailored surgical treatment carried out at our Institution. Material and Methods the approach provided the injection, six weeks before surgery, of 500 international units of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay. Results Postoperative superficial surgical site infection was successfully treated with negative pressure wound therapy. At one year follow up no hernia recurrence was recorded while total body weight loss was 31%. Conclusions a delay in ventral hernia repair could worsen quality of life of morbidly obese patients. In such high risk patients, the choice of the best surgical strategy remains controversial. There is great concern in performing bariatric surgery simultaneously to hernia repair, although there is lack of evidence on which is the ideal treatment modality. Synchronous bariatric surgery and complex ventral hernia repair should be approached in high volume centres where a consolidated experience of multidisciplinary team-work is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.

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