Botulinum Toxin Utilization for Abdominal Wall Reconstruction
Geoffrey Kozak1, Phoebe McAuliffe2, Corey Bascone1, Ankoor Talwar1, Abhishek Desai1, Robyn Broach1, Stephen Kovach1, John Fischer1
University of Pennsylvania, Philadelphia, PA
Introduction: Reconstruction of large incisional hernias (IH) presents a challenging surgical problem with high recurrence rates. Botulinum toxin (BTX) injection preoperatively has been proposed to facilitate closure of an open abdomen and more recently to assist in fascial closure during repair of incisional hernia. There is limited data on outcomes of patients who received botulinum toxin injections when compared to similar patients who did not. We aim to examine the outcomes of patients with incisional hernias who receive BTX injections prior to abdominal wall reconstruction.
Methods: A retrospective cohort study of adult patients from May 2019 to July 2021 who underwent IH repair after BTX abdominal wall injections was conducted. All patients underwent a standardized BTX treatment course followed by interval abdominal wall reconstruction. A matched cohort who underwent IH repair without BTX treatment from the same time period were identified. This control group was selected with comparable defect size and BMI to the BTX group. Clinical and demographic data were extracted from charts. Chi-square and t-tests were used for data analysis.
Results: Twenty patients underwent IH repair with BTX injections compared to 30 patients who did not. There was no difference in average age (58.6 and 61.4 years, p=0.514) nor BMI (32.9kg/m2 and 32.4kg/m2, p=0.813). Average abdominal wall defect size was 663.9cm2 in the BTX group and 608.43cm2 in the non-BTX group (p=0.513). Primary outcome of fascial closure was achieved in every patient in the BTX group (20/20) vs 86.7% (26/30) in the non-BTX group (p=0.089). There rate of component separation was lower in the BTX group (65.0% of the BTX group vs. 93.3%, p=0.01). The BTX group had higher rates of seroma (p=0.03) and longer surgery time, 4:07 vs 3:58 (p<0.01). Only one dehiscence occurred in the post-operative period (non BTX group). There was no difference in incidence of surgical site infection, abscess, delayed healing, respiratory failure requiring prolonged intubation and re-intubation, pulmonary embolism, acute kidney injury or length of stay.
Conclusions: When compared to similar patients in regards to defect size and BMI, patients receiving botulinum toxin injections into their abdominal wall musculature achieved greater rates of closure with without significant negative outcomes in the peri-operative period. We conclude that botox injection for large incisional hernias is safe and effective method for relaxation of abdominal wall muscle and assistance in the closure of large abdominal wall defects.
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