Botulinum Toxin Use in Complex Abdominal Wall Hernias

Abstract

Complex abdominal wall hernias are challenging clinical situations characterized by large fascial defects, lateral abdominal wall muscle retraction, and loss of abdominal domain. The use of botulinum toxin A to produce a flaccid paralysis or chemodenervation of the lateral abdominal wall has emerged as a promising tool in the hernia repair armamentarium to tackle these challenging situations in complex abdominal wall reconstruction. The effects of such temporary paralysis of the abdominal wall musculature have the potential benefits of decreasing intraabdominal pressure while increasing abdominal wall compliance and abdominal domain. The available published evidence remains sparse but several interesting preclinical and clinical observations have been made which provide insights into the potential role of botulinum toxin A in hernia surgery. Herein, we synthetize the available evidence, provide recommendations for its use, and stimulate further research in the area.