Botulinum toxin type A reducing extent of TAR procedure in patients with large postoperative hernias

Objective. To assess the feasibility of reducing the extent of TAR repair in patients with W3 postoperative ventral hernias through preliminary BTA injections into lateral abdominal muscles. Material and methods. The study included 47 patients with midline POVH classified as W3. Eleven patients (group 1) received injections of BTA 500 U four weeks prior to scheduled unilateral TAR procedure. Group 2 (n=36) underwent standard bilateral TAR without BTA injections. Group 1 was characterized by significantly higher ASA class (p=0.011), Tanaka index (0.23±0.01 vs. 0.19±0.02; p=0.001) and fascial defect width (16.8 cm vs. 15.3 cm; p=0.01) and length (18 cm vs. 14 cm; p=0.005). Both groups were comparable in other parameters. Results. After BTA administration, fascial defect width reduced from 16.8 to 12.96 cm (p<0.001) and Tanaka index reduced from 0.23 to 0.21 (p=0.002) in group 1. Unilateral TAR was successfully performed in 72.7% of patients. Group 1 demonstrated significantly shorter surgery time (158.1±11.0 vs. 287.8±87.0 min; p<0.001) and hospital-stay (4 vs. 8 days; p=0.02) with comparable rate of severe complications. No between-group differences in quality of life were observed after 6 months (p=0.596). Conclusion. Preoperative BTA administration in patients with large midline POVH allows for less extent of TAR repair.