Using botilinum toxin for abdominal wall reconstruction

Abstract

Objective: Review the current literature on the use of botulinum toxin type A (BTA) as a complement in complex abdominal wall surgery. Material and methods: PubMed and Cochrane Library electronic databases were searched for eligible studies on the use of BTA. After a review of the literature, 22 studies were identified in which the use of BTA in abdominal wall surgery was analyzed, associated or not with component separation techniques (CS), as well as the use of progressive preoperative pneumoperitoneum (PPP). Results: The effects and benefits of BTA showed a reduction in the transverse diameter of the hernia defect from 0.3 cm to 5.25 cm. The most often analyzed advantage in the studies is the elongation of the lateral muscles of the abdominal wall, which ranges between 2.44 cm and 4.5 cm. The combination of BTA with PPP showed a reduction of the VIH/VAC ratio (volume of incisional hernia/Volume of the abdominal cavity) from 2 to 15 % is observed. The final objective of BTA administration is to obtain a good fascial closure, with less tension, which is analyzed in all papers and is achieved in 75-100 % of the cases, except in one of the studies that was 40.9 %. The dose of BTA varies from 100 to 300 IU of onabotulinumtoxinA (Botox®) and up to 500 IU of abobotulinumtoxinA (Dysport®), from 3 to 5 injection sites on each side of the abdominal wall musculature, following anatomical references, ultrasound or electromyographically guided. The timing of the injection varies from 6 weeks prior to surgery to the previous day of surgery. Reported serious adverse effects are very rare. Some authors described abdominal bloating, weak cough or back pain, all of them of mild intensity and limited in time, controllable with the use of an abdominal binder and well tolerated by most patients. Conclusions: The use of BTA is spreading in abdominal wall surgery, although regimens for its administration and dosage aren't standardized, there is great heterogeneity between different groups. However, most of the authors conclude that the injection of BTA provides a flaccid paralysis of the lateral muscles of the abdominal wall, with elongation and decreasing the transverse diameter of the defect. This will help in a less tensioned fascial closure in most patients, providing a better management of postoperative pain without serious adverse effects associated.