Diagnostic value of shear wave elastography in assessing the effectiveness of preoperative botulinum toxin type A therapy in patients with postoperative ventral hernias W3.
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引用次数: 0
Abstract
Introduction: Complex W3 ventral hernias with loss of domain (LOD) pose challenges in abdominal wall reconstruction due to pathological retraction and increased stiffness of the lateral abdominal muscles. Preoperative botulinum toxin type A (BTA) facilitates tension-free closure, but objective assessment remains poorly standardized. Two-dimensional shear wave elastography (2D-SWE) enables non-invasive quantification of tissue stiffness.
Methods: This prospective study included 20 healthy volunteers (control) and 6 patients with EHS W3 ventral hernias. Reference stiffness values for external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were established using 2D-SWE. Patients underwent stiffness measurements before BTA, one month after BTA, and at 1,3,6,12 months postoperatively. All underwent Rives-Stoppa hernioplasty.
Results: Control reference values were 13.38 kPa (EO), 13.61 kPa (IO), and 15.23 kPa (TrA). Before BTA, hernia patients showed elevated EO (24.2 ± 4.8) and IO (20.6 ± 2.3) stiffness (p < 0.001), while TrA stiffness (17.8 ± 3.6) did not differ from controls (p = 0.09). One month after BTA, stiffness decreased (EO: 14.3 ± 2.4, p = 0.21 vs. controls; IO: 10.2 ± 1.8, p < 0.001; TrA: 9.6 ± 1.2, p < 0.001). Postoperative stiffness progressively declined through 12 months (EO: 7.8 ± 0.9; IO: 7.4 ± 0.8; TrA: 7.3 ± 0.4). Primary fascial closure was achieved in all patients without additional component separation.
Conclusions: 2D-SWE provides objective assessment of BTA-induced muscular relaxation and postoperative remodeling. Established control reference values enable reliable stratification of pathological stiffness and monitoring of therapeutic response, supporting personalized surgical planning.
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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