Use of botulinum toxin type a before abdominal wall hernia reconstruction.
BACKGROUND
Abdominal wall hernia repair after open abdomen management represents a surgical challenge, particularly due to muscle tension and lateral retraction. This study was designed to propose the use of Botulinum Toxin Type A (BTA) before abdominal wall hernia repair.


METHODS
A prospective study of patients with abdominal wall hernia after open abdomen management was undertaken between September 2007 and January 2009. Bilateral BTA application was performed under electromyographic guidance at the abdominal wall. Transverse abdominal wall defect measurement was practiced at weekly intervals: clinically, in the first two patients, and with CT scan in the following 10 patients. Surgical closure was scheduled if no further hernia defect reduction was noted. Patients were followed at monthly hospital visits.


RESULTS
In the first two patients, a hernia defect reduction of 50 and 47.2%, respectively, was documented by the third week after BTA application, with no further reduction. In the 10 patients under CT scan hernia defect measurement, when comparing the initial mean transverse defect measure and at 4 weeks after BTA application (13.85 +/- 1.49 cm vs. 8.6 +/- 2.07 cm), an overall mean reduction of 5.25 +/- 2.32 cm was observed (p < 0.001; 95% confidence interval, 3.59-6.91). Hernia repair was performed, with no recurrences at a mean follow-up of 9.08 months.


CONCLUSIONS
BTA application before abdominal wall hernia repair seems to be useful. The lateral muscles paralysis achieved and transverse hernia defect reduction allows a minimal tension closure. To our knowledge, this is the first report of BTA application before abdominal wall hernia reconstruction.
Ibarra-Hurtado
Tomas R
TR
Department of General Surgery, Antiguo Hospital Civil de Guadalajara, Av Circunvalación Dr Atl No 154 Col Independencia, Guadalajara, Jalisco 44340, México. tomasibarra2005@yahoo.com.mx
Nuño-Guzmán
Carlos M
CM
Echeagaray-Herrera
Jorge E
JE
Robles-Vélez
Everardo
E
de Jesús González-Jaime
José
J
D000009:Abdominal Muscles / Q000187:drug effects*; D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009213:Myography; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D055815:Young Adult
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A