ArticleHernia : the journal of hernias and abdominal wall surgery2025
Preoperative Botulinum Toxin A (BTA) injection in abdominal wall reconstruction for subxiphoid (M1) hernias.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- A practical algorithm for the combined use of preoperative progressive pneumoperitoneum and botulinum toxin A in large incisional hernia repair: learnings after 15 years of experience.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- Subxiphoid Incisional Hernia Following Cardiac Procedures: A Narrative Review.Journal of abdominal wall surgery : JAWS · 2025Review
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8 authors.
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Abstract
introductionPreoperative BTA assists with fascial closure during abdominal wall reconstruction. Its efficacy in subxiphoid (M1) hernias has been questioned with high rates of component separation techniques (CST) despite BTA. To assess the role of BTA in these hernias, we compared fascial closure and recurrence rates in patients with M1 hernias requiring CST with or without preoperative BTA.
methodsA prospectively maintained database at a tertiary hernia center was reviewed for M1 hernias who underwent CST, and grouped based on use of preoperative BTA. Standard univariate analysis was performed.
resultsOf 67 patients, 30 (44.8%) received preoperative BTA. BTA versus non-BTA groups had similar mean ages (56.0 ± 14.1vs.61.5 ± 11.8 years, p = 0.087), ASA score (p = 0.345), rate of diabetes (p = 0.421), and very large defect size (499.2 ± 185.5vs.416.1 ± 238.6 cm2,p = 0.144). In the BTA group, BMI was lower (28.9 ± 5.1vs.32.7 ± 7.2 kg/m2,p = 0.018), with fewer current smokers (0%vs.10.8%,p = 0.006), and more contaminated (20.0%vs.5.4%) and dirty cases (33.3%vs.13.5%) (p = 0.008). External oblique release was performed in 24 (80.0%) BTA patients versus 23 (62.2%) non-BTA (p = 0.179), posterior CST in 6 (20.0%) versus 14 (37.8%) (p = 0.133). Rates of bilateral CST (90.0%vs.94.6% p = 0.394), fascial closure (90.0%vs.94.6%,p = 0.650), overall wound complications (33.3%vs.43.2%,p = 0.458), and recurrence (6.7%vs.2.7%,p = 0.583) were similar with average follow up of 12.7 ± 18.8 versus 24.1 ± 28.2 months (p = 0.062).
conclusionRepair of very large M1 hernias requires high rates of CST despite preoperative BTA injection. When CST is needed, BTA as a preoperative adjunct does not appear to offer benefit in terms of fascial closure rates, frequency of bilateral CST, or risk of recurrence.
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