Department of Upper GI Surgery, St Peters Hospital, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
Department of Interventional Radiology, St Peters Hospital, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
Hernia. 2023 Jun;27(3):593-599. doi: 10.1007/s10029-023-02739-6. Epub 2023 Jan 12.
Complications of incisional hernia are amongst the commonest presentations to the emergency surgical take. Outcomes from emergency hernia repair are poor, particularly for those with complex defects and for the growing population of comorbid, high-risk patients. Attempts to avoid emergency surgery by improving success rates of non-operative management could prove hugely beneficial. Botulinum toxin A (Botox) is already used in the elective management of incisional hernia and this study evaluates if the relaxation produced could be used to augment the outcomes of conservative management of acutely presenting incisional hernia.
Patients presenting between October 2020 and April 2022 without evidence of visceral ischaemia, who had been selected for a non-operative approach, were given 300 units of Botox under image guidance to the abdominal wall in addition to standard conservative measures.
Twelve patients were eligible for Botox administration. Median age was 75 years and median BMI was 36.45 kg/m. All patients were high risk; minimum ASA score was 3, and median frailty score was 5. In ten patients, symptoms resolved following Botox allowing for discharge without further complication. Seven subsequently referred on to the abdominal wall team. Symptoms did not settle in the two remaining patients; one required emergency laparotomy and the second was palliated.
Botox may be a useful adjunct to established non-operative measures in patients with acute presentations of incisional hernia. It may improve the acute symptoms, eliminate the need for high-risk emergency surgery, or provide a bridge to abdominal wall reconstruction.
切口疝的并发症是急诊外科最常见的表现之一。急诊疝修补术的效果不佳，尤其是对于那些存在复杂缺损和患有多种合并症、高风险的患者。通过提高非手术治疗的成功率来避免急诊手术可能会带来巨大的益处。肉毒杆菌毒素 A（Botox）已被用于择期治疗切口疝，本研究评估了松弛效果是否可用于增强急性切口疝保守治疗的效果。
2020 年 10 月至 2022 年 4 月期间，我们对无内脏缺血证据、已选择非手术治疗的患者，在标准保守治疗的基础上，在腹壁影像引导下给予 300 单位的 Botox。
共有 12 名患者符合 Botox 给药条件。患者的中位年龄为 75 岁，BMI 中位数为 36.45kg/m。所有患者均为高风险患者；最低 ASA 评分为 3 分，中位脆弱评分 5 分。在 10 名患者中，Botox 治疗后症状缓解，无需进一步并发症即可出院。其中 7 名患者随后转诊至腹壁团队。另外 2 名患者的症状未缓解；其中 1 名患者需要紧急剖腹手术，另 1 名患者进行姑息治疗。
Botox 可能是急性切口疝患者接受既定非手术治疗的有用辅助手段。它可以改善急性症状，避免高危紧急手术，或为腹壁重建提供桥梁。
