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Erschienen in: Hernia 2/2020

04.04.2019 | Original Article

Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair

verfasst von: K. E. Elstner, J. W. Read, J. Saunders, P. H. Cosman, O. Rodriguez-Acevedo, A. S. W. Jacombs, R. T. Martins, N. Ibrahim

Erschienen in: Hernia | Ausgabe 2/2020

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Abstract

Introduction

Repair of complex ventral hernia presents a significant challenge plagued by high morbidity and recurrence. Recent studies have demonstrated significant benefits achievable with preoperative Botulinum Toxin A (BTA) chemical component paralysis to the abdominal wall muscles, facilitating primary closure of complex ventral hernia defects. However, transversus abdominis is known to play an integral role in truncal stability, and its paralysis can result in unwanted physiological changes. This is the first study to report on selective administration of preoperative BTA to internal and external oblique muscles only, thus sparing transversus abdominis from paralysis.

Methods

This is a prospective observational study of 46 patients who underwent either selective two-layer or standard three-layer abdominal wall muscle BTA injection prior to elective laparoscopic ventral hernia repair. Serial abdominal CT imaging was performed to compare defect size and length of the lateral abdominal musculature.

Results

46 patients received preoperative BTA injections (23 in each group). A comparison of gains achieved from chemical component paralysis demonstrated no statistically significant difference between the two groups. Fascial closure was achieved in all cases, with no post-operative sequelae of abdominal hypertension. There are no hernia recurrences to date.

Conclusion

Preoperative selective muscle chemical component paralysis is an effective technique to counteract the chronic muscle retraction observed in large ventral hernias. Transversus abdominis plays a significant role in truncal and spinal stability, and sparing it from paralysis preserves an important component of abdominal wall physiology and does not detract from the ability to primarily close complex defects.
Literatur
1.
Zurück zum Zitat Weissler JM, Lanni MA, Tecce MG et al (2017) Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia. J Plast Surg Hand Surg 51:366–374CrossRef Weissler JM, Lanni MA, Tecce MG et al (2017) Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia. J Plast Surg Hand Surg 51:366–374CrossRef
2.
Zurück zum Zitat Deerenberg EB, Timmermans L, Hogerzeil DP et al (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia 19:89–101CrossRef Deerenberg EB, Timmermans L, Hogerzeil DP et al (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia 19:89–101CrossRef
3.
Zurück zum Zitat Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135CrossRef Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135CrossRef
4.
Zurück zum Zitat Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399PubMedPubMedCentral Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399PubMedPubMedCentral
5.
Zurück zum Zitat Awad ZT, Puri V, LeBlanc K et al (2005) Mechanisms of ventral hernia recurrence after mesh repair and a new proposed classification. J Am Coll Surg 201:132–140CrossRef Awad ZT, Puri V, LeBlanc K et al (2005) Mechanisms of ventral hernia recurrence after mesh repair and a new proposed classification. J Am Coll Surg 201:132–140CrossRef
6.
Zurück zum Zitat Ramirez OM, Ruas E, Dellon AL (1990) “Components Separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526CrossRef Ramirez OM, Ruas E, Dellon AL (1990) “Components Separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526CrossRef
7.
Zurück zum Zitat Heller L, McNichols CH, Ramirez OM (2012) Component separations. Semin Plast Surg 26:25–28CrossRef Heller L, McNichols CH, Ramirez OM (2012) Component separations. Semin Plast Surg 26:25–28CrossRef
8.
Zurück zum Zitat Jardim YJ, Mesquita GHA, Pipek LZ et al (2018) Chemical components separation with the use of botulinum toxin A: a critical review for correction of ventral hernia. J Abdom Wall Reconstr 1:1002 Jardim YJ, Mesquita GHA, Pipek LZ et al (2018) Chemical components separation with the use of botulinum toxin A: a critical review for correction of ventral hernia. J Abdom Wall Reconstr 1:1002
9.
Zurück zum Zitat Zendejas B, Khasawneh MA, Srvantstyan B et al (2013) Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs. World J Surg 37:2830–2837CrossRef Zendejas B, Khasawneh MA, Srvantstyan B et al (2013) Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs. World J Surg 37:2830–2837CrossRef
10.
Zurück zum Zitat Ibarra-Hurtado TR, Nuno-Guzman CM, Echeagaray-Herrera JE et al (2009) Use of botulinum toxin type A before abdominal wall hernia reconstruction. World J Surg 33:2553–2556CrossRef Ibarra-Hurtado TR, Nuno-Guzman CM, Echeagaray-Herrera JE et al (2009) Use of botulinum toxin type A before abdominal wall hernia reconstruction. World J Surg 33:2553–2556CrossRef
11.
Zurück zum Zitat Ibarra-Hurtado TR, Nuno-Guzman CM, Miranda-Diaz AG et al (2014) Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia 18:647–652CrossRef Ibarra-Hurtado TR, Nuno-Guzman CM, Miranda-Diaz AG et al (2014) Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia 18:647–652CrossRef
12.
Zurück zum Zitat Zielinski MD, Goussous N, Schiller HJ et al (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17:101–107CrossRef Zielinski MD, Goussous N, Schiller HJ et al (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17:101–107CrossRef
13.
Zurück zum Zitat Farooque F, Jacombs A, Roussos E et al (2016) Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg 86:79–83CrossRef Farooque F, Jacombs A, Roussos E et al (2016) Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg 86:79–83CrossRef
14.
Zurück zum Zitat Elstner KE, Jacombs AS, Read JW et al (2016) Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A. Hernia 20:209–219CrossRef Elstner KE, Jacombs AS, Read JW et al (2016) Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A. Hernia 20:209–219CrossRef
15.
Zurück zum Zitat Elstner KE, Read JW, Rodriguez-Acevedo O (2017) Preoperative chemical component relaxation using Botulinum Toxin A: enabling laparoscopic repair of complex ventral hernia. Surg Endosc 31:761–768CrossRef Elstner KE, Read JW, Rodriguez-Acevedo O (2017) Preoperative chemical component relaxation using Botulinum Toxin A: enabling laparoscopic repair of complex ventral hernia. Surg Endosc 31:761–768CrossRef
16.
Zurück zum Zitat Rodriguez-Acevedo O, Elstner KE, Jacombs ASW et al (2018) Preoperative Botulinum Toxin A enabling defect closure and laparoscopic repair of complex ventral hernia defects. Surg Endosc 32:831–839CrossRef Rodriguez-Acevedo O, Elstner KE, Jacombs ASW et al (2018) Preoperative Botulinum Toxin A enabling defect closure and laparoscopic repair of complex ventral hernia defects. Surg Endosc 32:831–839CrossRef
17.
Zurück zum Zitat Smoot D, Zielinski M, Jenkins D et al (2011) Botox A injection for pain after laparoscopic ventral hernia: a case report. Pain Medicine 12:1121–1123CrossRef Smoot D, Zielinski M, Jenkins D et al (2011) Botox A injection for pain after laparoscopic ventral hernia: a case report. Pain Medicine 12:1121–1123CrossRef
18.
Zurück zum Zitat Rudmik LR, Schieman C, Dixon E et al (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119CrossRef Rudmik LR, Schieman C, Dixon E et al (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119CrossRef
19.
Zurück zum Zitat Heller L, Chike-Obi C, Xue AS (2012) Abdominal wall reconstruction with mesh and components separation. Semin Plast Surg 26:29–35CrossRef Heller L, Chike-Obi C, Xue AS (2012) Abdominal wall reconstruction with mesh and components separation. Semin Plast Surg 26:29–35CrossRef
20.
Zurück zum Zitat Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 109:2275–2282CrossRef Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 109:2275–2282CrossRef
21.
Zurück zum Zitat Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE (2000) Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg 105:720–729CrossRef Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE (2000) Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg 105:720–729CrossRef
22.
Zurück zum Zitat Maas SM, de Vries Reilingh TS, van Goor H, de Jong D, Bleichrodt RP (2002) Endoscopically assisted “components separation technique” for the repair of complicated ventral hernias. J Am Coll Surg 194:388–390CrossRef Maas SM, de Vries Reilingh TS, van Goor H, de Jong D, Bleichrodt RP (2002) Endoscopically assisted “components separation technique” for the repair of complicated ventral hernias. J Am Coll Surg 194:388–390CrossRef
23.
Zurück zum Zitat Rosen MJ, Williams C, Kin J, McGee MF, Schomisch S, Marks J, Ponsky J (2007) Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 194:385–389CrossRef Rosen MJ, Williams C, Kin J, McGee MF, Schomisch S, Marks J, Ponsky J (2007) Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 194:385–389CrossRef
24.
Zurück zum Zitat Dressler D (2012) Clinical applications of botulinum toxin. Curr Opin Microbiol 15:325–336CrossRef Dressler D (2012) Clinical applications of botulinum toxin. Curr Opin Microbiol 15:325–336CrossRef
25.
Zurück zum Zitat Ganong W (1995) Review of medical physiology 17th Ed. Appleton and Lange Ganong W (1995) Review of medical physiology 17th Ed. Appleton and Lange
26.
Zurück zum Zitat Haggmark T, Thorstensson A (1979) Fibre types in human abdominal muscles. Acta Physiol Scand 107:319–325CrossRef Haggmark T, Thorstensson A (1979) Fibre types in human abdominal muscles. Acta Physiol Scand 107:319–325CrossRef
27.
Zurück zum Zitat Hodges PW (2003) Neuromechanical stiffness of the spine. Thesis Dissertation. Karolinska Institute Hodges PW (2003) Neuromechanical stiffness of the spine. Thesis Dissertation. Karolinska Institute
28.
Zurück zum Zitat Hodges PW, Richardson CA (1998) Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord 11:46–56CrossRef Hodges PW, Richardson CA (1998) Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord 11:46–56CrossRef
29.
Zurück zum Zitat Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 21:2640–2650CrossRef Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 21:2640–2650CrossRef
30.
Zurück zum Zitat McGill SM, Grenier S, Kavcic N, Cholewicki J (2003) Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol 13:353–359CrossRef McGill SM, Grenier S, Kavcic N, Cholewicki J (2003) Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol 13:353–359CrossRef
31.
Zurück zum Zitat Hodges PW, Richardson CA (1997) Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res 114:362–370CrossRef Hodges PW, Richardson CA (1997) Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res 114:362–370CrossRef
Metadaten
Titel
Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair
verfasst von
K. E. Elstner
J. W. Read
J. Saunders
P. H. Cosman
O. Rodriguez-Acevedo
A. S. W. Jacombs
R. T. Martins
N. Ibrahim
Publikationsdatum
04.04.2019
Verlag
Springer Paris
Erschienen in
Hernia / Ausgabe 2/2020
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-019-01939-3

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