Departments of Plastic Surgery, National Institute of Medical Sciences and Nutrition, Mexico, Mexico.
Departments of General Surgery, National Institute of Medical Sciences and Nutrition, Mexico, Mexico.
World J Surg. 2024 Apr;48(4):881-886. doi: 10.1002/wjs.12112. Epub 2024 Feb 28.
In patients with large ventral hernias, botulinum toxin to external and internal oblique muscles decreases thickness and increases length. We examined the impact of botulinum toxin in the amount of loss of domain according to two ratios and in hernia size.
Between October 2021 and November 2023, 20 patients with ventral hernias measuring 10 cm or more on the horizontal size underwent the administration of 50 units of botulinum toxin to each external and each internal oblique muscle 4 weeks before their surgery. Incisional hernia volume to peritoneal volume ratio, volume ratio, and hernia size were compared before and 4 weeks after the injection of botulinum toxin. Comparisons between all variables obtained before and after the administration of botulinum toxin were performed using either the paired t-test or the Wilcoxon signed-rank test. Pearson correlation coefficient was used to analyze associations between initial conditions and further changes observed after botulinum toxin injection.
We observed a 42% reduction in muscle amplitude, 16% increase in intra-abdominal volume, 28% decrease in herniated volume, decreases of 6% in IHV/PV ratio and of 11% in V ratio, 11% reduction of hernia width, and decrease of 10% in rectangular and elliptical hernia areas.
In patients with large ventral hernias, botulinum toxin is associated with reduction of hernia size and decrease in loss of domain, the latter not being significant when less than 10% of the visceral block is herniated.
在患有大型腹侧疝的患者中，将肉毒毒素注射到腹外斜肌和腹内斜肌可减少厚度并增加长度。我们研究了根据两种比例和疝大小，肉毒毒素在域丢失量中的作用。
在 2021 年 10 月至 2023 年 11 月期间，对水平尺寸为 10cm 或更大的 20 例腹侧疝患者，在手术前 4 周分别向每块腹外斜肌和腹内斜肌注射 50 个单位的肉毒毒素。比较注射肉毒毒素前后切口疝体积与腹膜体积比、体积比和疝大小。使用配对 t 检验或 Wilcoxon 符号秩检验比较肉毒毒素给药前后所有变量之间的差异。使用 Pearson 相关系数分析肉毒毒素注射前后初始条件与进一步变化之间的关联。
我们观察到肌肉振幅降低了 42%，腹腔内体积增加了 16%，疝出体积减少了 28%，IHV/PV 比和 V 比分别减少了 6%和 11%，疝宽度减少了 11%，矩形和椭圆形疝面积分别减少了 10%。
在患有大型腹侧疝的患者中，肉毒毒素与疝大小的减少和域丢失的减少相关，当内脏疝出部分小于 10%时，后者无显著变化。
