Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 21; no. 2; pp. 233 - 243
• Main Authors: Bueno-Lledó, J., Torregrosa, A., Ballester, N., Carreño, O., Carbonell, F., Pastor, P. G., Pamies, J., Cortés, V., Bonafé, S., Iserte, J.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-04-2017; Springer Nature B.V
• Subjects: Abdominal Muscles - drug effects; Abdominal Surgery; Adult; Aged; Algorithms; Botulinum Toxins, Type A - administration & dosage; Feasibility Studies; Female; Hernia, Ventral - drug therapy; Hernia, Ventral - surgery; Herniorrhaphy - methods; Humans; Incisional Hernia - drug therapy; Incisional Hernia - surgery; Injections, Intramuscular; Male; Medicine; Medicine & Public Health; Middle Aged; Neuromuscular Agents - administration & dosage; Original Article; Pneumoperitoneum, Artificial - methods; Preoperative Care; Surgical Mesh; Large incisional hernia; Botulinum toxin A; Preoperative progressive pneumoperitoneum; Incisional hernia; Ventral hernia
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-017-1582-2

Purpose
Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH).
Methods
Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%.
Results
The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500–13.250), over a period of 14.3 ± 1.3 days (13–16). BT administration time was 40.2 ± 3.3 days (37–44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (
p
 < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12–60) and we reported 2 cases of hernia recurrence (4.4%).
Conclusions
Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.