Use of botulinum toxin in surgical preparation for complex incisional hernias

Main Article Content

João Kleber de Gentile
https://orcid.org/0000-0001-8650-2703
Amanda Salvati Beck Lima
Cassiana de Moura e Costa
Gabriella Muraro
Lorena Freitas da Silva

Abstract

Abdominal wall defects with incisional hernias after surgery represent a great challenge for surgeons due to their technical complexity for treatment, largely attributed to the retraction of the lateral muscles of the abdominal wall. Reconstruction of the abdominal wall is understood to re-functionalize it with the approximation of the rectus abdominis muscles through its midline. The use of botulinum toxin serotype A (TBA) has shown that its use produces a temporary flaccid paralysis in the abdominal muscles, favoring midline closure, caused by muscle flaccidity and greater complacency caused by the toxin. Abdominal hernias result in increased morbidity due to lung restriction, aerophagia, abdominal pain, constipation, and urinary alterations), with a consequent decrease in quality of life. The objective of this study is describe our initial experience with chemical separation of components using the TBA in Brazil.

Article Details

How to Cite
Gentile, J. K. de, Beck Lima , A. S., de Moura e Costa , C. ., Muraro , G. ., & Freitas da Silva, L. . (2022). Use of botulinum toxin in surgical preparation for complex incisional hernias. Brazilian Journal of Case Reports, 2(3), 75–82. https://doi.org/10.52600/2763-583X.bjcr.2022.2.3.75-82
Section
Experience Report
Author Biographies

João Kleber de Gentile, Faculdade de Medicina da Universidade Cidade de São Paulo (FM-UNICID)

Médico Cirurgião do Aparelho Digestivo. Membro Titular Especialista do Colégio Brasileiro de Cirurgia Digestiva (CBCD). Fellow of American College of Surgeons (FACS) Professor da Disciplina de Técnica Operatória e Habilidades Cirúrgicas da Faculdade de Medicina da Universidade Cidade de São Paulo (FM-UNICID). São Paulo, SP, Brazil.

Amanda Salvati Beck Lima , Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz

Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz. Cascavel, PR, Brazil.

Cassiana de Moura e Costa , Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz

Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz. Cascavel, PR, Brazil.

Gabriella Muraro , Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz

Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz. Cascavel, PR, Brazil.

Lorena Freitas da Silva, Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz

Aluno(a) de Ciências Médicas da Faculdade de Medicina do Centro Universitário Assis Gurgacz. Cascavel, PR, Brazil.

References

Hope WW, Tuma F. Incisional Hernia. 2021 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.

Berrevoet F. Prevention of Incisional Hernias after Open Abdomen Treatment. Front Surg. 2018 Feb 26;5:11. doi: 10.3389/fsurg.2018.00011.

Um P Jairam. Timmermans L. Eker Hasan H. Prevention of Incisional hernia with prophylactic onlay and sublay mesh reinforcement verus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomiseed controlled trial. Lancet. 2017. Aug 5. 390(10094):567-576. doi: 10.1016/S0140-6736(17)31332-6.

Bower C, Roth JS. Economics of abdominal wall reconstruction. Surg Clin North Am. 2013 Oct;93(5):1241-53. doi: 10.1016/j.suc.2013.06.007.

Reynolds D, Davenport DL, Korosec RL, Roth JS. Financial implications of ventral hernia repair: a hospital cost analysis. J Gastrointest Surg. 2013 Jan;17(1):159-66; discussion p.166-7. doi: 10.1007/s11605-012-1999-y.

Basta MN, Kozak GM, Broach RB, Messa CA 4th, Rhemtulla I, DeMatteo RP, Serletti JM, Fischer JP. Can We Predict Incisional Hernia?: Development of a Surgery-specific Decision-Support Interface. Ann Surg. 2019 Sep;270(3):544-553. doi: 10.1097/SLA.0000000000003472.

Walming S, Angenete E. Retrospective review of risk factors for surgical wound dehiscence and incisional hérnia. BMC Surg. 2017. Feb 22. 17(1):19. doi: 10.1186/s12893-017-0207-0.

Rosin D. Outcomes of Chemical Component Paralysis Using Botulinum Toxin for Incisional Hernia Repairs. World Journal of Surgery. 2013. Oct 1; 37 (12):2838-8.

Whitehead Clarke T, Windsor A. The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure. Frontiers in Surgery. 2021. Oct 1;8.

Mourad AP, De Robles MS, Winn RD. Low Dose Pre Operative Botulinum Toxin A Effectively Facilitates Complex Ventral Hernia Repair: A Case Report and Rewiew of the Literature. Medicina (Kaunas). 2020. Dec 28; 57 (1):14.

Ibarra-Hurtado TR, Nuño-Guzmán CM, Miranda-Díaz AG, Troyo-Sanromán R, Navarro-Ibarra R, Bravo-Cuéllar L. Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia. 2014 Oct;18(5):647-52.

Bueno-Lledó J, Torregrosa A, Ballester N, Carreño O, Carbonell F, Pastor PG, Pamies J, Cortés V, Bonafé S, Iserte J. Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia. 2017 Apr;21(2):233-243. doi: 10.1007/s10029-017-1582-2.

Bueno-Lledó J, Torregrosa Gallud A, Jiménez Rosellón R, Carbonell Tatay F, García Pastor P, Bonafé Diana S, Iserte Hernández J. Preoperative preparation of «loss of domain» hernia. Progressive pneumoperitoneum and botulinum toxin type A. Cir Esp. 2017 May;95(5):245-253. English, Spanish. doi: 10.1016/j.ciresp.2017.04.

Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol. 2010;55(1):8-14. doi: 10.4103/0019-5154.60343.

Farooque F, Jacombs AS, Roussos E, Read JW, Dardano AN, Edye M, Ibrahim N. Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg. 2016 Jan-Feb;86(1-2):79-83. doi: 10.1111/ans.13258.

Whitehead-Clarke T, Windsor A. The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure. Front Surg. 2021; 8: 753889. doi: 10.3389/fsurg.2021.753889.

Bueno-Lledó J, Martinez-Hoed J, Torregrosa-Gallud, Menéndez-Jiménez M, Pous-Serrano S. Botulinum toxin to avoid component separation in m midline large hérnias. Surg Journal. 2020. Vol 168, Issue 3, P543-549.

Weissler J M, Lanni M A, Tecce M G, Carney M J, Shubinets V, Fischer J P. Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hérnia. Journal of plastic surgery and hand surgery. 2017. doi: 10.1080/2000656X.2017.1285783.

Ibarra-Hurtado TR, Nuño-Guzmán CM, Miranda-Díaz AG, Troyo-Sanromán R, Navarro-Ibarra R, Bravo-Cuéllar L. Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia. 2014 Oct;18(5):647-52.

Ibarra-Hurtado TR, Nuño-Guzmán CM, Echeagaray-Herrera JE, Robles-Vélez E, de Jesús González-Jaime J. Use of botulinum toxin type a before abdominal wall hernia reconstruction. World J Surg. 2009 Dec;33(12):2553-6. doi: 10.1007/s00268-009-0203-3.

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