Preoperative Image-guided Botulinum Toxin A Injection in Complex Abdominal Wall Hernia Repair

Purpose: This study aimed to examine the effectiveness of preoperative image guided botulinum toxin A injection in achieving fascial closure and reducing recurrence rates after repair of complex incisional abdominal wall hernias. Material and Methods: A total of 32 patients, consisting of 14 males and 18 females, with complex incisional hernias who underwent image guided botulinum toxin A injection at a median 33 [28-38.3] days before surgery were included in this retrospective study. Their mean age was 59.4 ± 11.2 years. Abdominal computed tomography imaging was obtained prior to botulinum toxin A administration to characterize the hernia defects of 26 patients (81.3%, 26/32). The transverse and vertical abdominal wall defects were measured and recorded. Three-dimensional objects of the hernia sac and peritoneal cavity were created based on the delineated borders, and volumes were calculated. The loss of domain was determined using the following formula: where x represents the hernia sac volume and y represents the peritoneal volume. Under ultrasound guidance, the abdominal wall musculature was injected with 300 units of botulinum toxin A across six sites. The fascial closure rate and rate of hernia recurrence were the principal outcomes investigated. Results: Fascial closure was achieved in 29 patients (90.6%, 29/32). Recurrence was observed in two patients (6.3%, 2/32) over an average followup of 2.5 ± 1.5 years (maximum 6.5). Fascial closure was obtained in 12 out of 14 patients with previous hernia repairs (85.7%, 12/14). One botulinum toxin A related complication was observed-a weakened cough that resolved without further treatment. Conclusions: Botulinum toxin A is safe and effective in improving rates of fascial closure and reducing instances of reoccurrence in patients with complex incisional hernias.