Does sarcopenia have a negative impact on the efficacy of botulinum toxin A in the prehabilitation of patients undergoing incisional hernia repair? A multicentric retrospective study.
Aurélien Villemin, Théophile Delorme, Pablo Ortega-Deballon, Hessa Alsuwaidan, David Moszkowicz, Benoit Romain
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Abstract
Background: Botulinum toxin A (BTA) injections are increasingly used to prepare patients undergoing surgery for incisional hernias larger than 10 cm. The aim of this study was to analyze the impact of sarcopenia on the efficacy of BTA injection in lengthening the lateral abdominal muscles.
Methods: Between August 2018 and January 2024, patients with midline incisional hernias ≥ 10 cm undergoing preoperative BTA injections were included in a multicentric database. Sarcopenia was evaluated calculating the muscle area measured on a transverse CT scan at the level of the L3 lumbar vertebra. Muscle characteristics and the volumes of the incisional hernia and abdominal cavity were compared before and 4 to 6 weeks after BTA injection. The effect of BTA on muscle elongation was evaluated according to sarcopenia.
Results: Fifty-nine patients were included. Sarcopenia did not impair the efficacy of BTA in terms of length of the lateral abdominal wall muscles, with a 1.8 cm increase bilaterally in each group. Regarding the efficacy of BTA injection, 80% of patients experienced elongation of the lateral abdominal wall muscles. Failure of the injection therefore affected 20% of patients. These results were similar in both groups, regardless of sarcopenia. Analysis of the characteristics of 'responders' and 'nonresponders' revealed that 'nonresponders' had a greater length of the lateral abdominal wall muscles on the scan prior to BTA injection, likely due to less significant muscle retraction.
Conclusion: Sarcopenia did not impair the effectiveness of BTA in terms of elongation prior to incisional hernia repair.
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.
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