TY - JOUR
T1 - Prehabilitation of complex ventral hernia patients with Botulinum
T2 - a systematic review of the quantifiable effects of Botulinum
AU - Wegdam, J. A.
AU - de Vries Reilingh, T. S.
AU - Bouvy, N. D.
AU - Nienhuijs, S. W.
N1 - Publisher Copyright:
© 2020, Springer-Verlag France SAS, part of Springer Nature.
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented. Methods: A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence. Results: 14 studies were included (377 patients) with a HDW of median 12 (10–15) cm. A typical intervention consisted of 200–300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2 weeks pre-operatively and evaluated by CT just before the operation. The primary effect was a median LAWM elongation of 4.0 cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies). Conclusion: Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.
AB - Purpose: Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented. Methods: A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence. Results: 14 studies were included (377 patients) with a HDW of median 12 (10–15) cm. A typical intervention consisted of 200–300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2 weeks pre-operatively and evaluated by CT just before the operation. The primary effect was a median LAWM elongation of 4.0 cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies). Conclusion: Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.
KW - Abdominal wall compliance
KW - Botulinum
KW - Complex ventral hernia repair
KW - Complications
KW - Prehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85096346076&partnerID=8YFLogxK
U2 - 10.1007/s10029-020-02333-0
DO - 10.1007/s10029-020-02333-0
M3 - Review article
C2 - 33215244
AN - SCOPUS:85096346076
SN - 1265-4906
VL - 25
SP - 1427
EP - 1442
JO - Hernia
JF - Hernia
IS - 6
ER -