PDF(Pubmed)
Abstract：
Background Obtaining primary fascial closure following laparostomy can be difficult; especially with fascial retraction or large pre-existing fascial defects. Various techniques have been described in the literature which attempt to improve reapproximation rates. Most techniques described comprise the use of adjuncts including Bogota Bags, negative pressure dressings, anchor devices and various types of mesh. While most techniques achieve primary closure, less achieve primary fascial closure. Botulinum toxin A (BTA) has proven a beneficial adjunct in repairing large ventral herniae. While there is limited research in the use of BTA in the acute setting of laparostomy closure its benefits in elective repair may prove transferrable with the appropriate protocols. Method This retrospective study reviewed 12 cases where BTA was used as an adjunct to close laparostomy. It compared primary fascial closure rates to historical controls at the same institution. Results Seven males and five females. Median age 63.5 years. Median BMI 32.95. Median days from BTA injection to primary fascial closure 9.5. Median 18 days from primary operation to primary fascial closure. 83% of patients achieved primary fascial closure with the rest achieving partial closure with the residual defect bridged with biological mesh. At the time of review, there was only one resulting ventral hernia in a patient with a BMI of 51.7 at the time of surgery. Conclusion While BTA does not guarantee primary fascial closure in laparostomy this study would indicate it improves primary fascial closure rates and can be added to any other existing method for managing the open abdomen. As BTA can be injected via the open abdomen or with ultrasound guidance it can be performed by any appropriately trained surgeon, anaesthetist or radiologist making its use widely achievable. Retrospectively registered.
摘要：
背景技术在腹腔镜造口术后获得原发性筋膜闭合可能是困难的;尤其是对于筋膜回缩或大的预先存在的筋膜缺损。在文献中已经描述了各种试图提高重近似率的技术。所描述的大多数技术包括使用附件，包括波哥大袋，负压敷料,锚定装置和各种类型的网格。虽然大多数技术实现了初级闭合，较少实现原发性筋膜闭合。肉毒杆菌毒素A（BTA）已被证明是修复大型腹侧疝的有益辅助手段。尽管在腹腔镜造口术闭合的急性设置中使用BTA的研究有限，但通过适当的方案，选择性修复的益处可能被证明是可以转移的。方法回顾性分析12例以BTA为辅助闭式腹腔镜造口术的病例。它比较了同一机构的主要筋膜闭合率与历史控制。结果男7例,女5例。中位年龄63.5岁。BMI中位数32.95。从BTA注射到原发性筋膜闭合的中位天数9.5。从初次手术到初次筋膜闭合的中位数为18天。83％的患者实现了原发性筋膜闭合，其余患者实现了部分闭合，残留缺损用生物网状物桥接。在审查时，1例BMI为51.7的患者在手术时只有1例发生腹疝.结论虽然BTA不能保证腹腔镜造口术中的原发性筋膜闭合，但该研究表明它可以提高原发性筋膜闭合率，并且可以添加到任何其他现有的开放腹部管理方法中。由于BTA可以通过开放腹部注射或在超声引导下注射，因此可以由任何受过适当训练的外科医生进行，麻醉师或放射科医生使其广泛使用。追溯登记。
