Preoperative botulinum toxin in complex ventral hernia repair: A systematic review

Abstract

Purpose: Botulinum toxin type A (BTA) causes temporary flaccid muscle paralysis. It is hypothesized that BTA preoperative use aids primary fascial closure (PFC) in complex ventral hernia (CVH) repair, which is especially relevant due to the difficulty to achieve PFC, high rates of recurrence and postoperative complications in CVH. This systematic review was conducted to explore BTA's impact on the abdominal wall biomechanics (length and thickness) and postoperative outcomes (PFC, complications and recurrence) in CVH repair. Methods: A systematic review was performed in PubMed, CENTRAL and Scopus databases until January 2023. Search and study selection were carried out by two independent authors. Studies that investigate BTA injection into the abdominal wall prior to CVH repair were eligible for inclusion. The risk of bias was assessed through the National Institutes of Health Quality Assessment. Results: Out of 126 results, 14 were included for qualitative analysis, comprising 594 patients treated with BTA. The population and surgical approach were heterogeneous across studies. Generally, 200-300 units of Botox® or 500 units of Dysport ® were injected to 3 sites per hemiabdomen, 3 to 6 weeks prior to surgery. The abdominal muscle length increased between 2,5 and 4,5cm. No major post-injection complications were reported. Most studies report high PFC rates and low recurrence rates. Conclusion: BTA effectively elongates the abdominal wall and is a safe and easy procedure. Its use seems to aid PFC and reduce recurrence rates. High quality prospective data is currently needed to formulate administration and patient selection guidelines.