Soltanizadeh Sinor, Helgstrand Frederik, Jorgensen Lars N
Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark; and Department of Surgery, Zealand University Hospital, Køge, Denmark.
Plast Reconstr Surg Glob Open. 2017 Jun 21;5(6):e1358. doi: 10.1097/GOX.0000000000001358. eCollection 2017 Jun.
Repair of large incisional hernias remains a surgical and costly challenge. Temporary paralysis of the lateral abdominal wall muscles with topical administration of botulinum toxin A (BTA) is a new therapeutic concept, which may obviate the need for component separation technique (CST) for repair of large incisional hernias. Current literature on the administration of BTA as adjunct to surgical repair of abdominal incisional hernias was investigated.
The electronic databases PubMed and Embase were searched for eligible studies. Two independent investigators evaluated the literature. Data were sought regarding primary fascial closure with and without CST, safety, hernia recurrence, method of application, and preoperative radiological imaging.
Six cohort studies including a total of 133 patients receiving BTA were identified. No randomized or case-control studies were found. In total, 83.5% of the patients achieved primary fascial closure. Supplemental CST was necessary in 24.1% of the patients. Two patients developed hernia recurrence during follow-up. No postoperative complications or adverse events were considered related to the administration of BTA, except for impairment of postoperative coughing and sneezing. Additionally, radiological imaging showed that BTA increased the length of lateral abdominal muscles before surgery.
Preoperative administration of BTA increases muscle length and may facilitate primary fascial closure. Optimal administration is at least 2 weeks before repair, whereas the optimal dose of BTA remains to be defined. Carefully designed randomized controlled trials are warranted to identify patients who would benefit from BTA and to eliminate the confounding effect of CST.
大型切口疝的修复仍然是一项具有手术挑战性且成本高昂的任务。局部应用肉毒杆菌毒素A（BTA）使侧腹壁肌肉暂时麻痹是一种新的治疗理念，这可能无需采用用于修复大型切口疝的成分分离技术（CST）。我们对当前关于将BTA作为腹部切口疝手术修复辅助手段的文献进行了研究。
在电子数据库PubMed和Embase中检索符合条件的研究。两名独立研究人员对文献进行评估。收集了有关采用和未采用CST进行一期筋膜缝合、安全性、疝复发、应用方法以及术前放射影像学检查的数据。
确定了6项队列研究，共纳入133例接受BTA治疗的患者。未发现随机对照试验或病例对照研究。总体而言，83.5%的患者实现了一期筋膜缝合。24.1%的患者需要补充CST。两名患者在随访期间出现疝复发。除了术后咳嗽和打喷嚏功能受损外，未发现术后并发症或不良事件与BTA的应用有关。此外，放射影像学检查显示，BTA在术前增加了侧腹壁肌肉的长度。
术前应用BTA可增加肌肉长度，并可能有助于一期筋膜缝合。最佳应用时间是在修复前至少2周，而BTA的最佳剂量仍有待确定。有必要进行精心设计的随机对照试验，以确定能从BTA中获益的患者，并消除CST的混杂效应。
