Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair

Hashmi , K.S; Udeaja, Y.Z; Dastur, J; Allen, S; Das , P

Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair

Authors

Hashmi , K.S

Udeaja, Y.Z

Dastur, J

Allen, S

Das , P

Issue Date

2024

Type

Scientific Paper

Keywords

Research Subject Categories::MEDICINE::Surgery

Abstract

Abstract In the past, various techniques had been described to repair large complex ventral hernias. Laparoscopic technique of components separation showed low complication rates and better overall outcome. Recently, Botulinum Toxin A (BTA) has shown benefit in achieving tension-free repair. We describe here our multimodal technique combining BTA injection, laparoscopic anterior components separation (LACS) and open mesh repair. Ten consecutive cases performed over 3 years were studied. A standardised technique was used with a reasonably short learning curve. Patients who generally fit for general anaesthesia were offered surgery after detailed preoperative imaging work up and informed consent. Demographic details, preoperative risk stratification, intraoperative and postoperative outcomes were recorded and analysed. A structured step by step management strategy was adopted. Total ten (n = 10) cases with median age of 42.5 years (range 28-76 years), male to female ratio of 8:2 and median BMI of 32.6 were included. Three patients had pre-existing stomas. Median diameter of hernial defect was 10 cm, IQR 4.8 cm and range of 6-20 cm. No intraoperative or immediate complications were observed. Median hospital stay was 6 days. Two seromas (20%) and two return to theatre (20%) were observed. One recurrence (10%) was observed after median follow-up of 32 months. No 90-day mortality was recorded. Multimodal technique of BTA injection, LACS and midline mesh repair is a reproducible, safe and effective option to repair large complex ventral hernias. Keywords: Components separation; Hernia; Intraperitoneal mesh; Laparoscopic; Ventral hernia. © 2024. Italian Society of Surgery (SIC). PubMed Disclaimer Similar articles Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A. Elstner KE, Jacombs AS, Read JW, Rodriguez O, Edye M, Cosman PH, Dardano AN, Zea A, Boesel T, Mikami DJ, Craft C, Ibrahim N. Hernia. 2016 Apr;20(2):209-19. doi: 10.1007/s10029-016-1478-6. Epub 2016 Mar 7. PMID: 26951247 Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation. Chan DL, Ravindran P, Fan HS, Elstner KE, Jacombs ASW, Ibrahim N, Talbot ML. ANZ J Surg. 2020 Jan;90(1-2):67-71. doi: 10.1111/ans.15438. Epub 2019 Sep 30. PMID: 31566297 Preoperative chemical component relaxation using Botulinum toxin A: enabling laparoscopic repair of complex ventral hernia. Elstner KE, Read JW, Rodriguez-Acevedo O, Cosman PH, Dardano AN, Jacombs AS, Edye M, Zea A, Boesel T, Mikami DJ, Ibrahim N. Surg Endosc. 2017 Feb;31(2):761-768. doi: 10.1007/s00464-016-5030-7. Epub 2016 Jun 28. PMID: 27351658 Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia. 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Ann Plast Surg 66:551–556 - DOI - PubMed Show all 19 references MeSH terms Adult Aged Botulinum Toxins, Type A* / administration & dosage Combined Modality Therapy Female Hernia, Ventral* / surgery Herniorrhaphy* / methods Humans Laparoscopy* / methods Male Middle Aged Preoperative Care / methods Surgical Mesh* Treatment Outcome Substances Botulinum Toxins, Type A Related information MedGen LinkOut - more resources Full Text Sources Springer Medical MedlinePlus Health Information Miscellaneous NCI CPTAC Assay Portal

Citation

Hashmi KS, Udeaja YZ, Dastur J, Allen S, Das P. Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair. Updates Surg. 2024 Oct;76(6):2403-2409. doi: 10.1007/s13304-024-01822-6. Epub 2024 Mar 28. PMID: 38546968.