Chemical component separation with botulinum toxin type A in the management of complex midline ventral hernia: A prospective randomized controlled comparative study

Mohammed, Mohammed Ahmed; Zaghloul, Naser; Tohamy, Tohamy Abdallah; Mohammed, Ahmed Zaghloul

doi:10.21608/mjmr.2023.204011.1373

Chemical component separation with botulinum toxin type A in the management of complex midline ventral hernia: A prospective randomized controlled comparative study

Document Type : Original Article

Authors

¹ General Surgery, faculty of medicine, Minia Univerity

² General Surgery, faculty of medicine, Minia University

³ General surgery, faculty of medicine, Minia university, Minia, Egypt

⁴ Anasthesia, faculty of medicine, Cairo University

10.21608/mjmr.2023.204011.1373

Abstract

Introduction: The repair of complex ventral hernia poses a significant challenge, as there is currently no universally accepted evidence-based approach for its treatment. One of the primary issues that arise in such instances is the loss of domain, which leads to a subsequent rise in intra-abdominal pressure following the repair.

Patient & Methodology: A prospective, randomized, controlled cohort study was carried out at the General Surgery theater and Section 11(A) of Cairo University Hospitals, as well as the Department of General Surgery, Faculty of Medicine, Minia University, spanning from March 2020 to March 2022. The research encompassed a cohort of 51 patients who underwent elective surgical intervention for Complex Midline Ventral hernia repair, with or without loss of domain.

Results: our study comprised a total of 51 participants who were categorized into three distinct cohorts.Each group consisted of 17 patients.The first group was administered Botox exclusively, while the second group received Botox with PPP. The third group was subdivided into two subgroups, with five patients receiving PPP and 12 patients receiving no preoperative intervention. The incidence of intraoperative intestinal injury was 17.6% in the Botox group, 0.0% in the Botox with PPP group, and 29.4% in the control group. Recurrence was observed solely within the control group, with a prevalence of 5.8%.

Conclusion: the employment of a combined approach involving Botox and PPP for preoperative preparation represents an efficacious method for complex ventral hernia repair. This technique serves to mitigate the risk of ACS, intraoperative intestinal injury, and postoperative recurrence.

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