Preoperative Botulinum Toxin A (BTA) injection in abdominal wall reconstruction for subxiphoid (M1) hernias.

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-02-18 DOI:10.1007/s10029-025-03290-2

Monica E Polcz, Alexis M Holland, William R Lorenz, Sullivan Ayuso, Gregory T Scarola, Dau Ku, Vedra A Augenstein, B Todd Heniford

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引用次数: 0

Abstract

Introduction: Preoperative BTA assists with fascial closure during abdominal wall reconstruction. Its efficacy in subxiphoid (M1) hernias has been questioned with high rates of component separation techniques (CST) despite BTA. To assess the role of BTA in these hernias, we compared fascial closure and recurrence rates in patients with M1 hernias requiring CST with or without preoperative BTA.

Methods: A prospectively maintained database at a tertiary hernia center was reviewed for M1 hernias who underwent CST, and grouped based on use of preoperative BTA. Standard univariate analysis was performed.

Results: Of 67 patients, 30 (44.8%) received preoperative BTA. BTA versus non-BTA groups had similar mean ages (56.0 ± 14.1vs.61.5 ± 11.8 years, p = 0.087), ASA score (p = 0.345), rate of diabetes (p = 0.421), and very large defect size (499.2 ± 185.5vs.416.1 ± 238.6 cm2,p = 0.144). In the BTA group, BMI was lower (28.9 ± 5.1vs.32.7 ± 7.2 kg/m2,p = 0.018), with fewer current smokers (0%vs.10.8%,p = 0.006), and more contaminated (20.0%vs.5.4%) and dirty cases (33.3%vs.13.5%) (p = 0.008). External oblique release was performed in 24 (80.0%) BTA patients versus 23 (62.2%) non-BTA (p = 0.179), posterior CST in 6 (20.0%) versus 14 (37.8%) (p = 0.133). Rates of bilateral CST (90.0%vs.94.6% p = 0.394), fascial closure (90.0%vs.94.6%,p = 0.650), overall wound complications (33.3%vs.43.2%,p = 0.458), and recurrence (6.7%vs.2.7%,p = 0.583) were similar with average follow up of 12.7 ± 18.8 versus 24.1 ± 28.2 months (p = 0.062).

Conclusion: Repair of very large M1 hernias requires high rates of CST despite preoperative BTA injection. When CST is needed, BTA as a preoperative adjunct does not appear to offer benefit in terms of fascial closure rates, frequency of bilateral CST, or risk of recurrence.

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术前注射肉毒杆菌毒素A （BTA）在剑下疝腹壁重建中的应用。

术前BTA辅助腹壁重建时的筋膜闭合。尽管有BTA，但其在剑突下疝（M1）中的疗效一直受到高比率成分分离技术（CST）的质疑。为了评估BTA在这些疝中的作用，我们比较了术前有或没有BTA的需要CST的M1疝患者的筋膜闭合和复发率。方法：在三级疝中心前瞻性维护的数据库中回顾了接受CST的M1疝，并根据术前BTA的使用进行分组。进行标准单因素分析。结果：67例患者中，30例（44.8%）接受术前BTA治疗。BTA组与非BTA组的平均年龄（56.0±14.1vs.61.5±11.8岁，p = 0.087）、ASA评分（p = 0.345）、糖尿病发生率（p = 0.421）和非常大的缺陷尺寸（499.2±185.5vs.416.1±238.6 cm2,p = 0.144）相似。BTA组BMI较低（28.9±5.1vs.32.7±7.2 kg/m2,p = 0.018），吸烟者较少（0%vs.10.8%,p = 0.006），污染病例较多（20.0%vs.5.4%），脏病例较多（33.3%vs.13.5%）（p = 0.008）。24例（80.0%）BTA对23例（62.2%）非BTA (p = 0.179)， 6例（20.0%）后路CST对14例（37.8%）（p = 0.133）。双侧CST （90.0%vs.94.6% p = 0.394）、筋膜闭合（90.0%vs.94.6%,p = 0.650）、总伤口并发症（33.3%vs.43.2%,p = 0.458）和复发率（6.7%vs.2.7%,p = 0.583）相似，平均随访时间分别为12.7±18.8个月和24.1±28.2个月（p = 0.062）。结论：尽管术前注射了BTA，但修复非常大的M1疝仍需要很高的CST率。当需要CST时，BTA作为术前辅助手段在筋膜闭合率、双侧CST发生频率或复发风险方面似乎没有好处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.