Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: https://twitter.com/MarturanoMd.
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: https://twitter.com/SAyusoMD.
Surgery. 2023 Mar;173(3):756-764. doi: 10.1016/j.surg.2022.07.034. Epub 2022 Oct 11.
Complete fascial closure significantly reduces recurrence rates and wound complications in abdominal wall reconstruction. While component separation techniques have clear effectiveness in closing large abdominal wall defects, preoperative botulinum toxin A has emerged as an adjunct to aid in fascial closure. Few data exist comparing preoperative botulinum toxin A to component separation techniques, and the aim was to do so in a matched study.
A prospective, single-center, hernia-specific database was queried, and a 3:1 propensity-matched study of patients undergoing open abdominal wall reconstruction from 2016 to 2021 with botulinum toxin A versus component separation techniques was performed based on body mass index, defect width, hernia volume, and Centers for Disease Control and Prevention wound classification. Demographics, operative characteristics, and outcomes were evaluated.
Matched patients included 105 component separation techniques and 35 botulinum toxin A. There was no difference in tobacco use, diabetes, or body mass index (all P > .5). Hernia defects and volume were large for both the component separation techniques and botulinum toxin A groups (mean size: component separation techniques 286.2 ± 179.9 cm vs botulinum toxin A 289.7 ± 162.4 cm; P = .73) (mean volume: 1,498.3 + 2,043.4 cm vs 2,914.7 + 6,539.4 cm; P = .35). Centers for Disease Control and Prevention wound classifications were equivalent (CDC3 and 4%-39.1% vs 40.0%; P = .97). Component separation techniques were more frequently performed in European Hernia Society M1 hernias (21% vs 2.9%; P = .01). The botulinum toxin A group had fewer surgical site occurrences (32.4% vs 11.4%; P = .02) and surgical site infections (11.7% vs 0%; P = .04). In multivariate analysis, botulinum toxin A was associated with lower rates of surgical site occurrences (odds ratio = 5.3; 95% confidence interval [1.4-34.4]). There was no difference in fascial closure (90.5% vs 100%; P = .11) or recurrence (12.4% vs 2.9%; P = .10) with follow-up (22.8 + 29.7 vs 9.8 + 12.7 months; P = .13).
In a matched study comparing patients with botulinum toxin A versus component separation techniques, there was no difference in fascial closure rates or in hernia recurrence between the 2 groups. Preoperative botulinum toxin A can achieve similar outcomes as component separation techniques, while decreasing the frequency of surgical site occurrences.
完全筋膜闭合术可显著降低腹壁重建术后的复发率和伤口并发症。虽然分离技术在闭合大的腹壁缺损方面具有明显的效果，但术前肉毒毒素 A 已成为辅助筋膜闭合的一种方法。比较术前肉毒毒素 A 与分离技术的研究数据很少，本研究旨在进行匹配研究。
前瞻性、单中心、疝特异性数据库进行查询，并对 2016 年至 2021 年间接受开放式腹壁重建的患者进行了前瞻性、单中心、疝特异性数据库查询，并基于体重指数、缺损宽度、疝体积和疾病预防控制中心伤口分类进行了肉毒毒素 A 与分离技术的 3:1 倾向评分匹配研究。评估了患者的人口统计学、手术特征和结局。
匹配患者包括 105 例分离技术和 35 例肉毒毒素 A 组。两组患者的吸烟、糖尿病或体重指数均无差异（均 P>.5）。分离技术和肉毒毒素 A 组的疝缺损和体积均较大（平均大小：分离技术组 286.2 ± 179.9 cm 对肉毒毒素 A 组 289.7 ± 162.4 cm；P=.73）（平均体积：1498.3 ± 2043.4 cm 对 2914.7 ± 6539.4 cm；P=.35）。疾病预防控制中心的伤口分类相当（CDC3 和 4%-39.1%对 40.0%；P=.97）。分离技术更常应用于欧洲疝学会 M1 疝（21%对 2.9%；P=.01）。肉毒毒素 A 组的手术部位并发症发生率较低（32.4%对 11.4%；P=.02）和手术部位感染（11.7%对 0%；P=.04）。多变量分析显示，肉毒毒素 A 与较低的手术部位并发症发生率相关（比值比= 5.3；95%置信区间 [1.4-34.4]）。两组在筋膜闭合率（90.5%对 100%；P=.11）或复发率（12.4%对 2.9%；P=.10）方面无差异（随访 22.8 ± 29.7 对 9.8 ± 12.7 个月；P=.13）。
在比较肉毒毒素 A 与分离技术患者的匹配研究中，两组在筋膜闭合率或疝复发率方面无差异。术前肉毒毒素 A 可达到与分离技术相似的效果，同时降低手术部位并发症的发生率。
