Skip to main content
SpringerLink
Log in

Botulinum Toxin Aided Hernia Repair

  • Chapter
  • First Online:
Robotic Assisted Hernia Repair

Abstract

Adjuncts to aid in hernia repair can be useful in certain situations, especially as more complex hernias are being repaired. Botulinum toxin A (BTA) is an adjunct that can help increase intraabdominal volume and allow greater ease of repair for large hernias, including those with loss of domain. The evidence for BTA use prior to operative hernia repair is growing and some benefit is seen, with minimal risk. In this chapter, we will highlight the pharmacology as well as review current applications and evidence for the use of BTA for hernia repair. We will also describe our technique of administration.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jankovic J. Botulinum toxin: state of the art. Mov Disord. 2017;32(8):1131–8.

    Article  CAS  PubMed  Google Scholar 

  2. Dressler D. Clinical applications of botulinum toxin. Curr Opin Microbiol. 2012;15(3):325–36.

    Article  PubMed  Google Scholar 

  3. Dressler D, Bigalke H. Immunological aspects of botulinum toxin therapy. Expert Rev Neurother. 2017;17(5):487–94.

    Article  CAS  PubMed  Google Scholar 

  4. Sethi KD, Rodriguez R, Olayinka B. Satisfaction with botulinum toxin treatment: a cross-sectional survey of patients with cervical dystonia. J Med Econ. 2012;15(3):419–23.

    Article  PubMed  Google Scholar 

  5. Evidente VG, Truong D, Jankovic J, Comella CL, Grafe S, Hanschmann A. IncobotulinumtoxinA (Xeomin®) injected for blepharospasm or cervical dystonia according to patient needs is well tolerated. J Neurol Sci. 2014;346(1–2):116–20.

    Article  CAS  PubMed  Google Scholar 

  6. Ramirez-Castaneda J, Jankovic J, Comella C, Dashtipour K, Fernandez HH, Mari Z. Diffusion, spread, and migration of botulinum toxin. Mov Disord. 2013;28(13):1775–83.

    Article  CAS  PubMed  Google Scholar 

  7. Erbguth F, Claus D, Engelhardt A, Dressler D. Systemic effect of local botulinum toxin injections unmasks subclinical Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry. 1993;56(11):1235–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the guideline development Subcommittee of the American Academy of neurology. Neurology. 2016;86(19):1818–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg. 2010;251(5):843–56.

    Article  PubMed  Google Scholar 

  10. Deerenberg EB, Timmermans L, Hogerzeil DP, et al. A systematic review of the surgical treatment of large incisional hernia. Hernia. 2015;19(1):89–101.

    Article  CAS  PubMed  Google Scholar 

  11. Fink C, Baumann P, Wente MN, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101(2):51–4.

    Article  CAS  PubMed  Google Scholar 

  12. Elstner KE, Jacombs AS, Read JW, et al. Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using botulinum toxin a. Hernia. 2016;20(2):209–19.

    Article  CAS  PubMed  Google Scholar 

  13. Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237(1):129–35.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Novitsky YW. Hernia surgery: current principles. Cham: Springer; 2016.

    Google Scholar 

  15. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709–16.

    Article  PubMed  Google Scholar 

  16. Caldironi MW, Romano M, Bozza F, et al. Progressive pneumoperitoneum in the management of giant incisional hernias: a study of 41 patients. Br J Surg. 1990;77(3):306–7.

    Article  CAS  PubMed  Google Scholar 

  17. Dumont F, Fuks D, Verhaeghe P, et al. Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia. 2009;13(2):183–7.

    Article  CAS  PubMed  Google Scholar 

  18. Admire AA, Dolich MO, Sisley AC, Samimi KJ. Massive ventral hernias: role of tissue expansion in abdominal wall restoration following abdominal compartment syndrome. Am Surg. 2002;68(5):491–6.

    PubMed  Google Scholar 

  19. Ibarra-Hurtado TR, Nuño-Guzmán CM, Echeagaray-Herrera JE, Robles-Vélez E, de Jesús González-Jaime J. Use of botulinum toxin type a before abdominal wall hernia reconstruction. World J Surg. 2009;33(12):2553–6.

    Article  PubMed  Google Scholar 

  20. Jankovic J. Botulinum toxin : therapeutic clinical practice and science. Philadelphia, PA: Saunders/Elsevier; 2009.

    Google Scholar 

  21. Cakmak M, Caglayan F, Somuncu S, et al. Effect of paralysis of the abdominal wall muscles by botulinum a toxin to intraabdominal pressure: an experimental study. J Pediatr Surg. 2006;41(4):821–5.

    Article  PubMed  Google Scholar 

  22. Elstner KE, Read JW, Rodriguez-Acevedo O, et al. Preoperative chemical component relaxation using botulinum toxin a: enabling laparoscopic repair of complex ventral hernia. Surg Endosc. 2017;31(2):761–8.

    Article  PubMed  Google Scholar 

  23. Elstner KE, Read JW, Rodriguez-Acevedo O, Ho-Shon K, Magnussen J, Ibrahim N. Preoperative progressive pneumoperitoneum complementing chemical component relaxation in complex ventral hernia repair. Surg Endosc. 2017;31(4):1914–22.

    Article  PubMed  Google Scholar 

  24. Rodriguez-Acevedo O, Elstner KE, Jacombs ASW, et al. Preoperative botulinum toxin a enabling defect closure and laparoscopic repair of complex ventral hernia. Surg Endosc. 2018;32(2):831–9.

    Article  PubMed  Google Scholar 

  25. Farooque F, Jacombs AS, Roussos E, et al. Preoperative abdominal muscle elongation with botulinum toxin a for complex incisional ventral hernia repair. ANZ J Surg. 2016;86(1–2):79–83.

    Article  PubMed  Google Scholar 

  26. Ibarra-Hurtado TR, Nuño-Guzmán CM, Miranda-Díaz AG, Troyo-Sanromán R, Navarro-Ibarra R, Bravo-Cuéllar L. Effect of botulinum toxin type a in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia. 2014;18(5):647–52.

    Article  CAS  PubMed  Google Scholar 

  27. Elstner KE, Read JW, Jacombs ASW, et al. Single port component separation: endoscopic external oblique release for complex ventral hernia repair. Surg Endosc. 2018;32(5):2474–9.

    Article  PubMed  Google Scholar 

  28. Weissler JM, Lanni MA, Tecce MG, Carney MJ, Shubinets V, Fischer JP. Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia. J Plast Surg Hand Surg. 2017;51(5):366–74.

    Article  PubMed  Google Scholar 

  29. Bueno-Lledó J, Torregrosa A, Ballester N, et al. Preoperative progressive pneumoperitoneum and botulinum toxin type a in patients with large incisional hernia. Hernia. 2017;21(2):233–43.

    Article  PubMed  Google Scholar 

  30. Bueno-Lledó J, Torregrosa Gallud A, Jiménez Rosellón R, et al. Preoperative preparation of “loss of domain” hernia. Progressive pneumoperitoneum and botulinum toxin type a. Cir Esp. 2017;95(5):245–53.

    Article  PubMed  Google Scholar 

  31. Zendejas B, Khasawneh MA, Srvantstyan B, Jenkins DH, Schiller HJ, Zielinski MD. Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs. World J Surg. 2013;37(12):2830–7.

    Article  PubMed  Google Scholar 

  32. Zielinski MD, Goussous N, Schiller HJ, Jenkins D. Chemical components separation with botulinum toxin a: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia. 2013;17(1):101–7.

    Article  CAS  PubMed  Google Scholar 

  33. Zielinski MD, Kuntz M, Zhang X, et al. Botulinum toxin A-induced paralysis of the lateral abdominal wall after damage-control laparotomy: a multi-institutional, prospective, randomized, placebo-controlled pilot study. J Trauma Acute Care Surg. 2016;80(2):237–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Brown SH, McGill SM. Transmission of muscularly generated force and stiffness between layers of the rat abdominal wall. Spine (Phila Pa 1976). 2009;34(2):E70–5.

    Article  Google Scholar 

  35. Lien SC, Hu Y, Wollstein A, et al. Contraction of abdominal wall muscles influences size and occurrence of incisional hernia. Surgery. 2015;158(1):278–88.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Durham PL, Cady R. Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type a: implications for migraine therapy. Headache. 2004;44(1):35–42; discussion 42–33

    Article  PubMed  Google Scholar 

  37. Göbel H, Heinze A, Reichel G, Hefter H, Benecke R, Dysport myofascial pain study group. Efficacy and safety of a single botulinum type a toxin complex treatment (Dysport) for the relief of upper back myofascial pain syndrome: results from a randomized double-blind placebo-controlled multicentre study. Pain. 2006;125(1–2):82–8.

    Article  PubMed  CAS  Google Scholar 

  38. Childers MK, Wilson DJ, Gnatz SM, Conway RR, Sherman AK. Botulinum toxin type a use in piriformis muscle syndrome: a pilot study. Am J Phys Med Rehabil. 2002;81(10):751–9.

    Article  PubMed  Google Scholar 

  39. Perez D, Wildi S, Demartines N, Bramkamp M, Koehler C, Clavien PA. Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg. 2007;205(4):586–92.

    Article  PubMed  Google Scholar 

  40. Smoot D, Zielinski M, Jenkins D, Schiller H. Botox a injection for pain after laparoscopic ventral hernia: a case report. Pain Med. 2011;12(7):1121–3.

    Article  PubMed  Google Scholar 

  41. Oliveira LT, Essu FF, de Mesquita GHA, et al. Component separation of abdominal wall with intraoperative botulinum a presents satisfactory outcomes in large incisional hernias: a case report. Int J Surg Case Rep. 2017;41:99–104.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weum S, de Weerd L. Perforator-guided drug injection in the treatment of abdominal wall pain. Pain Med. 2016;17(7):1229–32.

    Article  PubMed  Google Scholar 

  43. Dressler D, Adib Saberi F, Bigalke H. IncobotulinumtoxinA (Xeomin(®)) can produce antibody-induced therapy failure in a patient pretreated with abobotulinumtoxinA (Dysport(®)). J Neural Transm (Vienna). 2014;121(7):769–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Talar Tejirian & Louise Yeung

Authors
  1. Talar Tejirian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Yeung
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Our Lady of the Lake Physician Group, Baton Rouge, LA, USA

    Karl A. LeBlanc

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tejirian, T., Yeung, L. (2019). Botulinum Toxin Aided Hernia Repair. In: LeBlanc, K. (eds) Robotic Assisted Hernia Repair. Springer, Cham. https://doi.org/10.1007/978-3-030-23025-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-23025-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23024-1

  • Online ISBN: 978-3-030-23025-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation