1
|
Schaaf S, Wöhler A, Gerlach P, Willms AG, Schwab R. [The use of botulinum toxin in hernia surgery: results of a survey in certified hernia centers]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02121-x. [PMID: 38918261 DOI: 10.1007/s00104-024-02121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Botulinum toxin application into the abdominal wall prior to major hernia repair can reduce the complexity of surgery and has been increasingly used in recent years, even if it is an off-label use. OBJECTIVE To what extent is botulinum toxin used in hernia surgery in German-speaking countries and what is the current evidence in the literature? MATERIAL AND METHODS In a voluntary online survey of German Society for General and Visceral Surgery (DGAV)-certified competence centers and reference centers for hernia surgery, aspects of botulinum toxin application were surveyed and the results analyzed. RESULTS A total of 57 centers took part in the survey, of which 27 (47%) use botulinum toxin. The main reasons for not using it were lack of experience and reimbursement. Of the centers 85% have treated less than 50 patients with botulinum toxin. The main indications were midline hernias (M2-4 according to the EHS classification) with a hernia gap > 10 cm (W3 according to EHS classification) and loss of domain situations. The application was predominantly ultrasound-guided by designated hernia surgeons with 100-200 Allergan or 500 Speywood units 4-6 weeks preoperatively and without complications related to the botulinum toxin application. CONCLUSION Botulinum toxin injections in hernia surgery appear to be safe and effective. Ultrasound-guided preoperative bilateral administration is supported by the available data. Specific course and information formats should be offered by the hernia surgery institutions.
Collapse
Affiliation(s)
- Sebastian Schaaf
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
| | - Aliona Wöhler
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - Patricia Gerlach
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - Arnulf G Willms
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - Robert Schwab
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| |
Collapse
|
2
|
Motii Y, Chahrour H, Harb A. Image guided preoperative abdominal wall botox injection for large ventral hernia repair: A case series. Radiol Case Rep 2024; 19:2315-2322. [PMID: 38559652 PMCID: PMC10978449 DOI: 10.1016/j.radcr.2024.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
This case series aims to explore the application of preoperative CT guided Botox injections in three different cases of abdominal wall reconstructions. Each of the three cases highlights the role of chemical component separation in achieving myofascial release and contributing to a successful surgical repair. The use of Botox in the preoperative planning of abdominal wall repair aims at creating a tension-free environment for midline closure and promoting an overall positive postoperative course for the patient. This case series presents as a valuable contribution to the different surgical approaches in abdominal wall reconstruction and the collaboration between Interventional Radiology and Surgery in treating such patients.
Collapse
Affiliation(s)
- Younes Motii
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA
| | - Hussein Chahrour
- Detroit Medical Center/Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
| | - Ali Harb
- Detroit Medical Center/Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
| |
Collapse
|
3
|
Huerta S, Raj R, Chang J. Botulinum Toxin A as an Adjunct for the Repair Giant Inguinal Hernias: Case Reports and a Review of the Literature. J Clin Med 2024; 13:1879. [PMID: 38610644 PMCID: PMC11012701 DOI: 10.3390/jcm13071879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The management of giant inguinoscrotal hernias remains a challenge as a result of the loss of the intra-abdominal domain from long-standing hernia contents within the scrotum. Multiple techniques have been described for abdominal wall relaxation and augmentation to allow the safe return of viscera from the scrotum to the intraperitoneal cavity without adversely affecting cardiorespiratory physiology. Preoperative progressive pneumoperitoneum, phrenectomy, and component separation are but a few common techniques previously described as adjuncts to the management of these massively large hernias. However, these strategies require an additional invasive stage, and reproducibility remains challenging. Botulinum toxin A (BTA) has been successfully used for the management of complex ventral hernias. Its use for these hernias has shown reproducibility and a low side effect profile. In the present report, we describe our institutional experience with BTA for giant inguinal hernias in two patients and present a review of the literature. In one case, a 77-year-old man with a substantial cardiac history presented with a giant left inguinal hernia that was interfering with his activities of daily living. He had BTA six weeks prior to inguinal hernia repair. Repair was performed via an inguinal incision with a favorable return of the viscera into the peritoneum. He was discharged on the same day of the operation. A second patient, 78 years of age, had a giant right inguinoscrotal hernia. He had a significant cardiac history and was treated with BTA six weeks prior to inguinal hernia repair via a groin incision. Neither patient had complaints nor recurrence at 7- and 3-month follow-ups. While the literature on this topic is scarce, we found 13 cases of inguinal hernias treated with BTA as an adjunct. BTA might be a promising adjunct for the management of giant inguinoscrotal hernias in addition to or in place of current strategies.
Collapse
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Roma Raj
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Jonathan Chang
- Department of Anesthesia and Pain Management, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| |
Collapse
|
4
|
El Shamarka AH, Zidan MH, Youssef MS, El Banna AH, Mourad M. A case of giant inguinoscrotal hernia managed by preoperative pneumoperitoneum with an unforeseen complication and outcome: a case report and review of literature. Hernia 2023; 27:1611-1615. [PMID: 37672132 DOI: 10.1007/s10029-023-02870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023]
Affiliation(s)
- A H El Shamarka
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt.
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt.
| | - M H Zidan
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| | - M S Youssef
- General Surgery Department, Alexandria Medical Research Institute Hospital, Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| | - A H El Banna
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| | - M Mourad
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| |
Collapse
|
5
|
Rombaldi MC, Barreto CG, Feldens L, Holanda F, Takamatu EE, Schopf L, Peterson CAH, Costa EC, Cavazzola LT, Isolan P, Fraga JC. Giant omphalocele: A novel approach for primary repair in the neonatal period using botulinum toxin. Rev Col Bras Cir 2023; 50:e20233582. [PMID: 37991062 PMCID: PMC10644868 DOI: 10.1590/0100-6991e-20233582-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/02/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A (BTA) in the repair of large abdominal wall defects in adults has been proven, and its reported use in children has recently grown. The goal of this study is to describe a novel technique for primary repair of GO using BTA during the neonatal period and report our initial experience. METHODS patients were followed from August 2020 to July 2022. BTA was applied to the lateral abdominal wall in the first days of life followed by surgical repair of the abdominal defect. RESULTS while awaiting surgery, patients had minimal manipulation, without requiring mechanical ventilation, were on full enteral feeding, and in contact with their parents. The midline was approximated without tension and without the need for additional techniques or the use of a prosthesis. Patients were discharged with repaired defects. CONCLUSION this approach represents a middle ground between staged and the nonoperative delayed repairs. It does not require aggressive interventions early in life, allowing maintenance of mother-child bonding and discharge of the patient with a repaired defect without the need for additional techniques or the use of a prosthesis. We believe that this technique should be considered as a new possible asset when managing this complex condition.
Collapse
Affiliation(s)
- Marcelo Costamilan Rombaldi
- - Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas - Porto Alegre - RS - Brasil
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Caroline Gargioni Barreto
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Letícia Feldens
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Felipe Holanda
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Eliziane Emy Takamatu
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Luciano Schopf
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | | | - Eduardo Corrêa Costa
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Leandro Totti Cavazzola
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Geral - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| | - Paola Isolan
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| | - José Carlos Fraga
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| |
Collapse
|
6
|
Serafio-Gómez JL, Aragón-Quintana C, Bustillos-Ponce M, Varela-Barraza O, Silva B. Effective Management of Giant Ventral Hernias: A Comprehensive Approach Combining Preoperative Botulinum Toxin Application, Modified Ramírez's Component Separation, and Rives-Stoppa Hernioplasty. Cureus 2023; 15:e48967. [PMID: 38024062 PMCID: PMC10659588 DOI: 10.7759/cureus.48967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Giant ventral hernias are a surgical challenge due to their size and the need for a specialized approach during repair. Over the decades, abdominal wall surgery has evolved into a sophisticated field with a wide range of techniques aimed at improving patient outcomes. However, there is no universally accepted method suitable for repairing all giant ventral hernias. Surgeons must rely on a combination of techniques, choosing the approach that best matches their expertise, available resources, and the individual patient's specific needs. This article explores the effective use of a combination of techniques, including preoperative botulinum toxin application, modified Ramírez's component separation, and Rives-Stoppa hernioplasty, yielding excellent results and minimizing recurrences. Objective This study aims to provide a comprehensive literature review of giant ventral hernias. Additionally, we aim to share our experience in managing and repairing giant ventral hernias using a multi-modal approach, combining various surgical techniques with a focus on patient safety, reduced recurrence rates, and improved quality of life. Methods Between October 1, 2019, and October 1, 2021, six patients with giant ventral hernias were enrolled at our department of surgery. They received preoperative botulinum toxin A (BT) application, underwent corrective surgery involving modified component separation following the Ramírez method, and received Rives-Stoppa hernioplasty. Follow-up was conducted for at least six months. Results Six patients were included in the study: three women and three men. They had an average age of 53.6 years and an average body mass index of 31.8 kg/m2. The most common location of the hernia defect was supra and infraumbilical, among 66% of cases. The primary adverse effect associated with BT application was abdominal distension, reported in 33% of patients. No postoperative complications, such as abscesses or seromas, were observed. After the surgical procedure, the average hospital stay was 2.6 days, and no recurrences were noted within six months post-surgery. Conclusion The proposed method, which involves a combination of techniques, has demonstrated promising results based on our experience. However, to solidify these findings and better understand the full scope of this approach, further comprehensive statistical studies involving larger populations are essential. These studies will not only validate our results but also provide valuable insights for optimizing the management of giant ventral hernias.
Collapse
Affiliation(s)
- José Luis Serafio-Gómez
- General Surgery, Chihuahua City General Hospital "Dr. Salvador Zubirán Anchondo", Chihuahua, MEX
| | - César Aragón-Quintana
- General Surgery, Chihuahua City General Hospital "Dr. Salvador Zubirán Anchondo", Chihuahua, MEX
| | - Melanie Bustillos-Ponce
- General Medicine, Chihuahua City General Hospital "Dr. Salvador Zubirán Anchondo", Chihuahua, MEX
| | - Omar Varela-Barraza
- General Surgery, Hospital Regional de Alta Especialidad del Bajío, León, MEX
| | - Beatriz Silva
- General Medicine, Chihuahua City General Hospital "Dr. Salvador Zubirán Anchondo", Chihuahua, MEX
| |
Collapse
|