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.

The Synthetic Scaffolds for Ventral Hernia Repair: Perspectives for Regenerative Surgery—Systematic Review

Ventral hernia (VH) frequently affects patients after abdominal surgery. The use of a mesh is often recommended. Different materials are described, from synthetic non-resorbable meshes to biological meshes. New generation meshes, also named scaffolds, aim to combine the advantages of both materials. The aim of this review is to provide an overview of the cytological, histological, biomechanical, and clinical outcomes of the use of the newest resorbable synthetic scaffolds in VH repair, based on experimental studies in a pre-clinical setting. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. Only experimental studies were included. Outcome parameters were building technique, in vitro cytocompatibility, in vivo histocompatibility, biomechanical analysis, and clinical outcomes. The articles included were nine. The total number of cases treated was 257. Materials analyzed included electrospun silk fibroin (SF)/poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) hybrid scaffolds, biodegradable polyester poly-ε-caprolactone (PCL) in the form of nanofibers, biodegradable mesh in poly-4-hydroxybutyrate (P4HB), nanofibrous polylactic acid (PLA) scaffold with a polypropylene (PP) material to generate a sandwich-like mesh, the collagen sponge (CS) group, the hybrid scaffold (HS) containing CS and poly-L-lactide (PLLA), and the hybrid scaffold (HS) + bone marrow (HSBM). Resorbable synthetic scaffolds are new, safe, surgical materials for the treatment or prevention of ventral hernia in animal models. Scaffolds should be tested in a contaminated surgical field for emergency use. Rigorous schematic indications for data collection are needed to improve the quality of the data in order to definitively clarify the pathway involved in inflammatory induced response.