[Botox preceding ventral hernia repair: it's not about esthetics]

Ventral hernia is a common complication after laparotomy. The aim during ventral hernia repair is to close the abdomen through medialization of the rectus muscles. Particularly in patients with large ventral hernia, chronically retracted lateral muscles may preclude muscle medialization and therewith closure of the abdomen. A recent development in abdominal wall surgery is the injection of botulinum toxin (botox) in the lateral abdominal wall muscles a few weeks prior to surgery. These intramuscular injections cause a temporary partial paralysis resulting in elongation of the lateral muscles, compared to pre-botox contracted and retracted lateral muscles, and therewith facilitate closure of the abdomen. Despite positive first results only little is known about this new application of botox. In this article we discuss both the technical aspects as well as the current state of this new technique.