Abstract：
OBJECTIVE: Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application.
METHODS: A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated.
RESULTS: Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%.
CONCLUSIONS: BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.
METHODS: A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated.
RESULTS: Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%.
CONCLUSIONS: BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.
摘要：
目的：A型肉毒杆菌毒素（BTA）是一种辅助工具，用于腹壁重建（AWR）前复杂疝的术前优化。本研究旨在研究BTA应用后腹腔和疝囊尺寸的变化。
方法：一项前瞻性研究，对27例疝缺损≥10cm且区域丢失（LOD）≥20％的患者进行了AWR。在应用BTA之前和之后进行计算机断层扫描（CT）测量和体积测定。评估术中和术后结果。
结果：BTA后成像显示疝宽度减少1.9cm（p=0.002），外侧腹壁肌肉伸长3.1cm（p<0.001），疝体积减少（HV）从2.9±0.9L到2.4±0.8L（p<0.001），腹腔容积（ACV）从9.7±2.5L增加到10.3L±2.4L（p=0.003），HV/ACV比从30.2±5%降低到23.4±6%(p<0.001)。92.6％的病例实现了筋膜闭合，而78％的病例需要进行成分分离。肺动脉压力的平均变化为3.53cmH2O，并且没有记录到术后呼吸衰竭。在90天的随访中，伤口发病率为25%，计划外再入院的比例为11%,疝复发7.4%。
结论：BTA可在腹壁产生可测量的体积变化，并有助于筋膜闭合。需要进一步的研究来确定BTA在复杂疝修补手术中的作用。
方法：一项前瞻性研究，对27例疝缺损≥10cm且区域丢失（LOD）≥20％的患者进行了AWR。在应用BTA之前和之后进行计算机断层扫描（CT）测量和体积测定。评估术中和术后结果。
结果：BTA后成像显示疝宽度减少1.9cm（p=0.002），外侧腹壁肌肉伸长3.1cm（p<0.001），疝体积减少（HV）从2.9±0.9L到2.4±0.8L（p<0.001），腹腔容积（ACV）从9.7±2.5L增加到10.3L±2.4L（p=0.003），HV/ACV比从30.2±5%降低到23.4±6%(p<0.001)。92.6％的病例实现了筋膜闭合，而78％的病例需要进行成分分离。肺动脉压力的平均变化为3.53cmH2O，并且没有记录到术后呼吸衰竭。在90天的随访中，伤口发病率为25%，计划外再入院的比例为11%,疝复发7.4%。
结论：BTA可在腹壁产生可测量的体积变化，并有助于筋膜闭合。需要进一步的研究来确定BTA在复杂疝修补手术中的作用。
