Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France.
Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Hernia. 2021 Dec;25(6):1507-1517. doi: 10.1007/s10029-021-02387-8. Epub 2021 Mar 9.
Incisional hernia with loss of domain (IHLD) remains a surgical challenge. Its management requires complex approaches including specific preoperative and intra-operative techniques. This study focuses on the interest of adding preoperative botulinum toxin A (BTA) injection to preoperative progressive pneumoperitoneum (PPP), compared to PPP alone.
Patients between January 2015 and March 2020 with IHLD who underwent pre-operative preparation were included. Their baseline characteristics were retrospectively analyzed, along with the characteristics of their incisional hernia before and after preparation including CT-scan volumetry. Intra-operative data, early post-operative outcomes, surgical site occurrences (SSOs) including surgical site infection (SSI) were recorded.
Four hundred and fifty (450) patients with incisional hernia were operated, including 41 patients (9.1%) with IHLD, 13 of which had both BTA and PPP, while 28 had PPP only. Both groups were comparable in term of patients and IHLD characteristics. Median increase in the volume of the abdominal cavity (VAbC) was + 55% for the entire population (+ 58.3% for the BTA-PPP group, p < 0.0001 and + 52.8% for the PPP-alone group, p < 0.0001) although the increase in volume was not different between the two groups (p = 0.99). Complete fascial closure was achieved in all patients. SSOs were more frequent in the PPP-alone group than in the BTA-PPP group (17 (60.7%) versus 3 (23.1%) patients, respectively, p = 0.043).
BTA and PPP are both useful in pre-operative preparation for IHLD. Combining both significantly increases the volume of abdominal cavity but associating BTA to PPP does not add any volumetric benefit but may decrease the post-operative SSO rate.
切口疝伴脏器移位（IHLD）仍然是一个外科挑战。其治疗需要包括特定术前和术中技术在内的复杂方法。本研究重点关注在术前逐步气腹（PPP）的基础上，加入术前肉毒毒素 A（BTA）注射的效果，与单独使用 PPP 相比。
纳入 2015 年 1 月至 2020 年 3 月期间接受 IHLD 术前准备的患者。回顾性分析其基线特征，以及其切口疝术前和准备后的特征，包括 CT 扫描体积测量。记录术中数据、术后早期结果、手术部位并发症（SSO），包括手术部位感染（SSI）。
共对 450 例切口疝患者进行了手术，其中 41 例（9.1%）为 IHLD，其中 13 例患者同时接受了 BTA 和 PPP，28 例仅接受了 PPP。两组患者和 IHLD 特征均具有可比性。在整个人群中，腹腔体积的中位数增加了+55%（BTA-PPP 组增加了+58.3%，p<0.0001，而 PPP 组增加了+52.8%，p<0.0001），尽管两组之间的体积增加没有差异（p=0.99）。所有患者均实现了筋膜完全闭合。PPP 组的 SSO 发生率高于 BTA-PPP 组（分别为 17（60.7%）例和 3（23.1%）例，p=0.043）。
BTA 和 PPP 都可用于 IHLD 的术前准备。两者结合可显著增加腹腔体积，但联合使用 BTA 和 PPP 并不能增加体积获益，反而可能降低术后 SSO 发生率。
