Preoperative Botulinum Toxin Type A Use in Giant Inguinal Hernia Repair: A Scoping Review

Area of Science:

• Surgical Innovation
• Hernia Repair
• Abdominal Wall Reconstruction

Background:

• Giant inguinal hernias (GIHs) present significant surgical challenges due to loss of domain and reduced abdominal wall compliance.
• Preoperative botulinum toxin type A (BtxA) is used in ventral hernia repair to improve abdominal wall relaxation, but its application in GIHs is not well-defined.

Purpose of the Study:

• To conduct a scoping review of the literature on preoperative BtxA use in GIHs repair.
• To identify technical protocols, patient selection criteria, and areas of variability in BtxA administration for GIHs.

Main Methods:

• A comprehensive scoping review following PRISMA-ScR guidelines.
• Searched MEDLINE, Embase, Web of Science, and Scopus from inception to October 2025.
• Included observational and non-comparative studies reporting preoperative BtxA in adult GIHs repair patients.

Main Results:

• Seven studies (2019-2025) involving 16 patients were analyzed.
• Significant heterogeneity observed in BtxA dosage (100-450 units), timing (2-8 weeks), and injection sites (6-18).
• BtxA was often part of multimodal strategies; all studies targeted lateral abdominal muscles with imaging guidance and bilateral injections.

Conclusions:

• Preoperative BtxA use in GIHs repair is currently limited and highly variable.
• No standardized protocol for BtxA administration in GIHs repair has been established.
• Further systematic, anatomically focused studies are necessary to clarify BtxA's role and develop standardized protocols for GIHs.