Botulotoxin in hernia surgery

Large complex ventral hernias with the loss of domain (LOD) are one of the most challenging areas of hernia surgery due to the technical difficulty of the surgical procedures, the high risk of complications, limited possibilities of abdominal wall reconstruction and the complex primary closure of the fascia. Surgical procedures used in abdominal wall reconstruction have recently made significant progress. As part of preoperative preparation, the application of botulinum toxin type A into the lateral muscle groups of the abdominal wall is increasingly used as one of the methods. The effect of botulinum toxin causes temporary paralysis of muscle fibers, increases the compliance of the fascia and subsequently reduces the transverse dimension of the defect, which facilitates its closure.

The case report outlines our experience with preoperative application of botulinum toxin type A in a patient with a primary ventral hernia associated with the LOD phenomenon. Botulinum toxin injection into the three layers of the lateral abdominal muscles was performed four weeks before the operation aiming to achieve temporary paralysis of the muscle fibers. This procedure contributed to an increase in the volume of the abdominal cavity and a reduction in the transverse dimension of the hernial defect, as confirmed by a CT imaging. Finally, abdominal reconstruction was performed using the Rives-Stoppa method. The patient's postoperative course was uneventful, with no complications observed.

This case report aims to demonstrate the use of botulinum toxin in the management of large abdominal wall hernias, as well as to highlight its potential benefits in borderline cases, where it may serve as an alternative to more invasive procedures such as component separation. We also emphasize the importance of a comprehensive evaluation of the hernia, extending beyond the simple measurement of defect width. Botulinum toxin represents a straightforward, minimally invasive, and clinically effective technique that is increasingly expanding therapeutic options available in modern hernia surgery.