Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. May 21, 2019; 9(1): 1-6
Published online May 21, 2019. doi: 10.5412/wjsp.v9.i1.1
Role of botulinum toxin a in the management of complex incisional hernias
Christos Farazi-Chongouki, Dimitrios Filippou
Christos Farazi-Chongouki, Dimitrios Filippou, Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Athens 11521, Greece
Author contributions: Farazi-Chongouki C and Filippou D conceived the study and drafted the manuscript; both authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dimitrios Filippou, MD, PhD, Assistant Professor, Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, 22 D. Soutsou Street, Athens 11521, Greece. d_filippou@hotmail.com
Telephone: +30-6944-287125
Received: February 22, 2019
Peer-review started: February 26, 2019
First decision: March 25, 2019
Revised: April 1, 2019
Accepted: April 26, 2019
Article in press: April 28, 2019
Published online: May 21, 2019

Despite the technological breakthroughs and discover of abdominal meshes, ventral hernia has always been challenging in therapeutic strategies by the surgeons, with high recurrence rates. The use of botulinum toxin A (BTA) for the management of ventral and incisional hernia (IH) poses an increasingly interesting practice, especially for the intimidating complex one. The preoperative administration of the toxin to the lateral abdominal muscles by use of Ultra-Sound guidance causes muscle paralysis and a reduction of intra-abdominal pressure. Thus, the hernia defect can be primarily closed without tension, if the length of the defect is up to 10 cm. In larger hernia, this method can be combined with component separation techniques or the use of a mesh. The mesh placement seems to be better by laparoscopy. The site of injection and the dosage of BTA are still under discussion amongst authors. The optimal administration is proposed by some authors to be at least 2 weeks before repair. There is also an analgesic effect of BTA to the patients that underwent hernia reconstruction. Ultimately, the role of BTA in the reconstruction of ventral hernia seems to be promising, but there is a necessity for several randomized clinical trials.

Keywords: Ventral hernias and botox, Incisional hernias, Botulinum toxin A, Botox

Core tip: Administration of botulinum toxin A (BTA) in the surgical repair of ventral, incisional and complex hernia is a useful method, even for large hernia defects. The toxin is intramuscularly injected under Ultra-Sound guidance, covering all layers of the lateral abdominal muscles. The neurotoxic and analgesic activity of BTA leads to tension-free hernia closure. There is an increasing use of the technique especially in laparoscopic mesh repair. However, future data analysis will demonstrate the results and the benefits of this interesting procedure.