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Implementing preoperative Botulinum toxin A and progressive pneumoperitoneum through the use of an algorithm in giant ventral hernia repair

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Abstract

Background

Repair of large ventral hernias with loss of domain can be facilitated by preoperative Botulinum toxin A (BTA) injections and preoperative progressive pneumoperitoneum (PPP). The aim of this study is to evaluate the outcomes of ventral hernioplasty using a standardized algorithm, including component separation techniques, preoperative BTA and PPP.

Methods

All patients between June 2014 and August 2018 with giant hernias (either primary or incisional) of more than 12 cm width were treated according to a previously developed standardized algorithm. Retrospective data analysis from a prospectively collected dataset was performed. The primary outcome was closure of the anterior fascia. Secondary outcomes included complications related to the preoperative treatment, postoperative complications, and recurrences.

Results

Twenty-three patients were included. Median age was 65 years (range 28–77) and median BMI was 31.4 (range 22.7–38.0 kg/m2). The median loss of domain was 29% (range 12–226%). For the primary and secondary endpoints, 22 patients were analyzed. Primary closure of the anterior fascia was possible in 82% of all patients. After a median follow-up of 19.5 months (range 10–60 months), 3 patients (14%) developed a hernia recurrence and 16 patients (73%) developed 23 surgical site occurrences, most of which were surgical site infections (54.5%).

Conclusion

Our algorithm using both anterior or posterior component separation, together with preoperative BTA injections and PPP, achieved an acceptable fascial closure rate. Further studies are needed to explore the individual potential of BTA injections and PPP, and to research whether these methods can prevent the need for component separation, as postoperative wound morbidity remains high in our study.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Y. Yurtkap and M. M. J. van Rooijen contributed equally and both should be considered first authors.

Authors and Affiliations

  1. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Y. Yurtkap, M. M. J. van Rooijen & J. F. Lange

  2. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    S. Roels & J. M. L. Bosmans

  3. Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium

    O. Uyttebroek & F. Berrevoet

  4. Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands

    J. F. Lange

  5. Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000, Gent, Belgium

    F. Berrevoet

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  1. Y. Yurtkap
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Correspondence to F. Berrevoet.

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The authors confirm that the study was approved by the local institutional ethics committee of Ghent University Hospital and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Yurtkap, Y., van Rooijen, M.M.J., Roels, S. et al. Implementing preoperative Botulinum toxin A and progressive pneumoperitoneum through the use of an algorithm in giant ventral hernia repair. Hernia 25, 389–398 (2021). https://doi.org/10.1007/s10029-020-02226-2

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  • DOI: https://doi.org/10.1007/s10029-020-02226-2

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