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Preoperative botulinum toxin A injection in complex abdominal wall reconstruction- a propensity-scored matched study
Eva Barbara Deerenberg1, Jenny Meng Shao2, Sharbel Adib Elhage3
1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA; Department of Surgery, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045PM, Rotterdam, the Netherlands.
Introduction:
Fascial closure during complex abdominal wall reconstruction (AWR) improves recurrence and wound infection rates. To facilitate fascial closure in massive ventral hernias preoperative Botulinum Toxin A (BTA) injection can be used.
Methods:
2:1 propensity-scored matching of patients undergoing AWR with and without BTA was performed based on BMI, defect width, and loss of domain using CT-volumetric analysis.
Results:
145 patients without BTA and 75 with BTA were comparable on hernia size (240vs251cm2, p = 0.589) and hernia volume (1405vs1672cm3, p = 0.243). Patients with BTA had higher wound class (CDC≥3 37%vs13%, p < 0.001). Patients with BTA had a higher fascial closure rate (92%vs81%, p = 0.036), received more components separation (61%vs47%, p = 0.042), lower wound infection rate (12%vs26%,p = 0.019) and comparable recurrence rates (9%vs12%, p = 0.589). Recurrences occurred more often without complete fascial closure compared to patients with (33%vs7%, p < 0.001).
Conclusion:
In patients with massive ventral hernias and severe loss of domain, preoperative BTA-injection improves fascial closure rates during AWR.
