Observational studyHernia : the journal of hernias and abdominal wall surgery2026
Loss of domain incisional hernia: challenges simplified by standardizing the use of botulinum toxin A and preoperative progressive pneumoperitoneum.
Observational study in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe purpose of the current paper is to propose standardized indications and practical protocols for the use of Botulinum Toxin A (BTA) and Preoperative Progressive Pneumoperitoneum (PPP) in the management of LOD incisional hernia.
methodsA retrospective observational study at a tertiary care hospital in a developing country analyzed 29 patients with LOD incisional hernia (Tanaka Index > 0.25) from June 2019 to June 2025. Patients underwent BTA administration four weeks preoperatively, with PPP added for those with Tanaka Index > 0.35. Preoperative CT imaging assessed hernia sac and abdominal cavity volumes. Surgical repair utilized the Madrid modification of Posterior Component Separation with Transversus Abdominis Release and Fleur-de-lis abdominoplasty. Outcomes included Tanaka Index changes, fascial closure success, complications (Clavien-Dindo classification), and recurrence rates.
resultsThe mean Tanaka Index significantly decreased from 0.39 ± 0.06 to 0.19 ± 0.02 (p < 0.0001), and the mean hernia defect width reduced from 16.13 ± 2.27 cm to 8.36 ± 1.15 cm (p < 0.0001). Fascial closure was achieved in all patients. Postoperative complications included one case of reactionary hemorrhage (3.45%), three superficial surgical site infections (10.34%), two cases of basal atelectasis (6.89%), and two minor seromas (6.89%). Only one recurrence (3.45%) was observed during a median follow-up of four years. One patient (7.6%) undergoing PPP reported transient shoulder tip pain.
conclusionA protocol-driven approach using BTA and selective PPP effectively reduces hernia dimensions, enables tension-free fascial closure, and minimizes complications in LOD incisional hernia repair, offering a viable strategy in resource-constrained settings.
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