Botox in Complex Abdominal Wall Surgery

Botulinum toxin type A (BT) has been reported as a therapeutic option to facilitate tension-free fascial closure in complex abdominal wall hernia surgery. This neurotoxin causes a reversible flaccid paralysis of the lateral abdominal wall muscles, and has been considered as a “chemical component separation”, expanding abdominal domain by stretching and flattening of the retracted and contractured lateral abdominal wall muscles. BT optimizes preoperative preparation of patients with large ventral hernias and loss of domain, reducing intrabdominal pressure on reconstructed abdominal wall and increasing the abdominal domain prior to elective hernia repair. 

BTA injection technique, however, is not a universally standard technique due to unavailability in many centers and excessive variability of application. Although some working groups have reported their experience, they are not uniformly protocolized yet.

It is important to share experiences of the current state of scientific knowledge on this topic so that appropriate consensus can be reached. The goal of this research topic is to coordinate and collect reports from centers where preoperative BT is administered.

The specific themes we would like contributors to address include:

1. To unify indications of BT in complex abdominal wall surgery

2. Techniques of BT application

3. Is downstaging of a hernia repair possible using BT?

4. What does BT achieve in large hernias?

5. Is it possible to report experiences with BT type B?

6. Are there complications related to BT application before abdominal wall surgery?

7. What are the long-term outcomes of hernia repair after BT application?

8. Can we measure objectively the gain on lateral and medial muscles after BT?

9. Does BT have the same effect in lateral than midline hernia defects?

10. Results with combination of BT and other adjunct techniques like progressive preoperative pneumoperitoneum.