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Adjunct botox to preoperative progressive pneumoperitoneum for incisional hernia with loss of domain: no additional effect but may improve outcomes

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Abstract

Introduction

Incisional hernia with loss of domain (IHLD) remains a surgical challenge. Its management requires complex approaches including specific preoperative and intra-operative techniques. This study focuses on the interest of adding preoperative botulinum toxin A (BTA) injection to preoperative progressive pneumoperitoneum (PPP), compared to PPP alone.

Material

Patients between January 2015 and March 2020 with IHLD who underwent pre-operative preparation were included. Their baseline characteristics were retrospectively analyzed, along with the characteristics of their incisional hernia before and after preparation including CT-scan volumetry. Intra-operative data, early post-operative outcomes, surgical site occurrences (SSOs) including surgical site infection (SSI) were recorded.

Results

Four hundred and fifty (450) patients with incisional hernia were operated, including 41 patients (9.1%) with IHLD, 13 of which had both BTA and PPP, while 28 had PPP only. Both groups were comparable in term of patients and IHLD characteristics. Median increase in the volume of the abdominal cavity (VAbC) was + 55% for the entire population (+ 58.3% for the BTA-PPP group, p < 0.0001 and + 52.8% for the PPP-alone group, p < 0.0001) although the increase in volume was not different between the two groups (p = 0.99). Complete fascial closure was achieved in all patients. SSOs were more frequent in the PPP-alone group than in the BTA-PPP group (17 (60.7%) versus 3 (23.1%) patients, respectively, p = 0.043).

Conclusion

BTA and PPP are both useful in pre-operative preparation for IHLD. Combining both significantly increases the volume of abdominal cavity but associating BTA to PPP does not add any volumetric benefit but may decrease the post-operative SSO rate.

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Authors and Affiliations

  1. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France

    A. Tashkandi, J. Durtette-Guzylack, A. Cayeux, R. Rhaeim, R. Kianmanesh & Y. Renard

  2. Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia

    A. Tashkandi

  3. Unit of Abdominal Wall Surgery. Department of Digestive Surgery. Hospital, Universitari I Politecnic “La Fe”. University of Valencia, Valencia, Spain

    J. Bueno-Lledó

  4. King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    R. Bukhari

  5. Department of Anesthesia Robert, Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France

    J. M. Malinovski

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  1. A. Tashkandi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ahmad Tashkandi, Jules Durtette-Guzylack, Antoine Cayeux and Yohann Renard. The first draft of the manuscript was written by Ahmad Tashkandi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to A. Tashkandi.

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The present study includes patients operated on using routine and local standards. The two techniques reported in the present article were locally protocolized for a long time and followed the current state-of-the-science of incisional hernia management.

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Informed consent was obtained from all individual participants included in the study.

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The folders of all patients were retrospectively analyzed. All patients received adequate information and gave their written informed consent to be operated on following our local protocol.

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Tashkandi, A., Bueno-Lledó, J., Durtette-Guzylack, J. et al. Adjunct botox to preoperative progressive pneumoperitoneum for incisional hernia with loss of domain: no additional effect but may improve outcomes. Hernia 25, 1507–1517 (2021). https://doi.org/10.1007/s10029-021-02387-8

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