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Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum

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Abstract

Purpose

Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented.

Methods

A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence.

Results

14 studies were included (377 patients) with a HDW of median 12 (10–15) cm. A typical intervention consisted of 200–300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2 weeks pre-operatively and evaluated by CT just before the operation. The primary effect was a median LAWM elongation of 4.0 cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies).

Conclusion

Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.

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Availability of data and material (data transparency)

All data available at request by first author and results of multi-database search are provided in supplementary material.

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  1. Department of Surgery, Elkerliek Hospital, Postbus 98, 5700 AB, Helmond, The Netherlands

    J. A. Wegdam & T. S. de Vries Reilingh

  2. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    S. W. Nienhuijs

  3. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    N. D. Bouvy

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All authors agreed with the content and all gave explicit consent to submit. JW had the idea for the article, JW and TSVR performed the literature search and data analysis, JW drafted and SN and NB critically revised the work.

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Wegdam, J.A., de Vries Reilingh, T.S., Bouvy, N.D. et al. Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum. Hernia 25, 1427–1442 (2021). https://doi.org/10.1007/s10029-020-02333-0

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