J. M. Weissler1, M. A. Lanni1, M. G. Tecce1, M. J. Carney1, V. Shubinets1, J. P. Fischer1 1University Of Pennsylvania,Plastic Surgery,Philadelphia, PA, USA
Introduction: Incisional hernia (IH) remains a challenging and costly surgical complication with high morbidity and exceptionally high recurrence rates. With nearly 350,000 repairs and a cost burden of $3.2 billion annually, there is a clear need for reparative strategies to thwart recurrence and the dramatic physiologic changes to the abdominal wall musculature after hernia. Botulinum toxin (Botox) injections have recently been identified as a potential preoperative means to counteract abdominal wall tension, reduce hernia size, and facilitate ultimate fascial closure. This systematic review and meta-analysis reviews outcomes after Botox injections in the setting of ventral hernia, and demonstrates the applicability of Botox in abdominal wall reconstruction.
Methods: A systematic review of the literature was conducted in accordance with PRISMA guidelines using MeSH terms “ventral hernia”, “herniorrhaphy”, “hernia repair”, and “botulinum toxins.” Relevant studies reporting pre- and post-injection data were included. Outcomes of interest included changes in hernia defect width and lateral abdominal muscle length, recurrence, complications, and patient follow-up. Qualitative findings were also considered to help demonstrate valuable themes across the literature.
Results: Overall, 164 titles were identified following the initial database search from which 11 articles were reviewed. 3 titles were ultimately included in the quantitative analysis, with a total of 56 patients. The remaining articles were considered qualitative in nature and analyzed the subjective effects of Botox. Meta-analysis revealed significant hernia width reduction (mean= 5.79cm; n=29; p<0.001) and lateral abdominal wall muscular lengthening (mean= 3.33cm; n=44; p<0.001) following Botox injections (Table 1). Mean length of follow-up was 24.7 months (range 9-49). The specific metrics before and after Botox injections for each hemi-abdomen were also included in the analysis.
Conclusion: While traditional abdominal wall reconstruction approaches have unquestionable benefits, Botox injections of the abdominal wall also offer tremendous potential in managing complex ventral hernias. This minimally invasive “chemical component separation” technique may provide crucial tissue mobility, minimize undue abdominal wall tension, and decrease abdominal muscle contractile force facilitating fascial closure, with a potentially easier postoperative recovery for the patient. Although further studies are needed, there is a significant opportunity to bridge the knowledge gap in preoperative practice measures for ventral hernia risk reduction.
