Study of morphological changes observed on abdominal CT scan after preoperative treatment with botulinum toxin type a in patients with midline incisional hernias or lateral component.

Introduction: Preoperative treatment with botulinum toxin (BT) is very common in complex incisional hernias, although it lacks clear indications.

Methods: Between July 2019 and May 2022, measurements of the thickness and length of the lateral abdominal wall, transverse diameter of the abdomen and diameter of the hernia defect were taken from patient CT scans both pre- and post-treatment with BT at our hospital. In order to establish differences between patients with lateral and midline hernias, a logistic regression analysis was performed.

Results: The study included 23 patients: 17 had midline hernias, and 6 had lateral hernias (4 right and 2 bilateral). We observed increased length of the right wall (1.15 ± 1.64 cm; P = .0029), left wall (1.96 ± 1.74 cm; P < .0001) and transverse abdominal diameter (2.85 ± 4.83 cm; P < .0001), and a reduction in the thickness of the right (-0.54 ± 0.53 cm; P < .0001) and left walls (-0.58 ± 0.42 cm; P < .0001). There were no differences in the transverse diameter of the defect (-0.01 ± 1.37 cm; P = .4593). After logistic regression, increased right wall length (OR 14.99; 95%CI 1.58 - 142.12) and transverse abdominal diameter (OR 9.33; 95%CI 1.13 - 76.68) was more likely to be observed in patients with midline hernias than in those with lateral locations.

Conclusions: Preoperative treatment with BT appears to be more effective in patients with midline hernias than in those with lateral locations.