Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Bo
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REVIEW
Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum J. A. Wegdam1 · T. S. de Vries Reilingh1 · N. D. Bouvy3 · S. W. Nienhuijs2 Received: 17 June 2020 / Accepted: 2 November 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
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. Keywords Complex ventral hernia repair · Abdominal wall compliance · Prehabilitation · Botulinum · Complications
Introduction The main principles in complex ventral hernia repair are to optimize the patient, to achieve primary fascial closure and to use mesh reinforcement following, if needed, a component Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10029-020-02333-0) contains supplementary material, which is available to authorized users. * J. A. Wegdam [email protected] 1
Department of Surgery, Elkerliek Hospital, Postbus 98, 5700 AB Helmond, The Netherlands
2
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
3
Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
separation technique (CST) [1]. Despite innovations in surgical techniques and meshes, expert centers still report high rates of wound complications (up to 35%) and medical complications (up to
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