title: Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair.
abstract: BACKGROUND
  Surgical repair of recurrent abdominal incisional hernia(s) can be challenging due to complex operative conditions, intense post-operative pain, potential respiratory compromise and lateral muscle traction predisposing to early recurrence. We report our preliminary results with botulinum toxin A (BTA) injection causing flaccid paralysis (relaxation) of the lateral abdominal wall muscles prior to surgery.
  
  
  METHODS
  A prospective pilot study measured the effect of preoperative BTA prior to elective repair of recurrent abdominal hernias. Under ultrasound control, 2 weeks prior to surgery, 50 units of BTA was injected into the external oblique, internal oblique and transversus abdominis muscles at three sites on each side of the lateral abdominal wall (total dose 300 units). Pre- and post-BTA abdominal computed tomography measured changes in abdominal wall muscle thickness and length. All hernias were repaired with laparoscopic or laparoscopic-assisted mesh techniques in a single or two-staged procedure.
  
  
  RESULTS
  Eight patients received BTA injections which were tolerated with no complications. Post-BTA preoperative computed tomography showed a significant increase in mean length of lateral abdominal wall from 18.5 cm pre-BTA to 21.3 cm post-BTA (P = 0.017) with a mean unstretched length gain of 2.8 cm per side (range 0.8-6.0 cm). All hernias were surgically reduced with mesh with no early recurrence.
  
  
  CONCLUSIONS
  Preoperative BTA injection prior to complex abdominal hernia repair is a safe procedure that causes flaccid relaxation, elongation and thinning of the lateral abdominal muscles and decrease in hernia defect. Although further evaluation is required, BTA injections may be a useful adjunct to surgical repair of complex incisional hernias.
authors.affiliation: Department of General Surgery, St Vincent's Hospital Darlinghurst, Sydney, New South Wales, Australia.
authors.forename: Faisal
authors.identifier: http://orcid.org/0000-0002-7500-129X
authors.initials: F
authors.lastname: Farooque
authors.affiliation: Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Anita S W
authors.initials: AS
authors.lastname: Jacombs
authors.affiliation: Macquarie University Hospital, Macquarie Hospital, Sydney, New South Wales, Australia.
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Roussos
authors.affiliation: Castlereagh Imaging, Sydney, New South Wales, Australia.
authors.forename: John W
authors.initials: JW
authors.lastname: Read
authors.affiliation: Department of Plastic and Reconstructive Surgery, Boca Raton Regional Hospital, Boca Raton, Florida, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Dardano
authors.affiliation: Macquarie University Hospital, Macquarie Hospital, Sydney, New South Wales, Australia.|Department of Surgery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Edye
authors.affiliation: Macquarie University Hospital, Macquarie Hospital, Sydney, New South Wales, Australia.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Ibrahim
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects* / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019274:Botulinum Toxins, Type A
keywords: botulinum toxin A; component separation; incisional hernia; lateral abdominal wall; preoperation