Hamburg Hernia Center, Hamburg, Germany.
Agaplesion Bethesda Hospital Bergedorf, Hamburg, Germany.
Hernia. 2024 Dec;28(6):2273-2283. doi: 10.1007/s10029-024-03156-z. Epub 2024 Sep 13.
Preoperative botolinum toxin A (BTA) administration to the lateral abdominal wall has been widely used since its introduction for treating complex abdominal wall defects and loss of domain (LOD) hernias. Intraoperative fascial traction (IFT) is an established technique for complex abdominal wall hernias exceeding a width of 10 cm and has also shown auspicious results. We present our single center data including 143 consecutive cases combining both techniques from 2019 to 2023. Aim of the study was to develop an algorithm for a tailored approach for very large and complex ventral abdominal wall hernias.
Consecutive patients treated with preoperative BTA and IFT from August 2019 to December 2023 were identified in our prospectively maintained database and reviewed retrospectively. Metrics included intraoperative findings and short-term (30 days) postoperative outcomes.
143 patients were included in our retrospective analysis. The mean age was 58.9 years and 99% of all patients had an ASA Score of II or III with a mean body mass index of 32.4 kg/m. The mean intraoperative reduction of fascia-to-fascia after BTA and IFT was 9.81 cm. 14 patients either had a lateral defect or a combination of a midline and lateral hernia. An additional uni- or bilateral transverse abdominis release (TAR) was necessary in 43 cases (30.1%). The overall surgical site occurrence rate (SSO) was 30.1% of which 13.8% were surgical site infections (SSI). Re-operation and SSO rates were significantly higher if an additional TAR was performed (both p = 0.001; α = 0.05).
IFT in combination with BTA is a transformative and clinically proven tool in the surgeons' toolbox. It might be an easier, and less invasive alternative to other available techniques in many cases, but it should not be looked at as an ultimate stand-alone method to treat all complex W3 hernias.
自肉毒杆菌毒素 A（BTA）在治疗复杂腹壁缺损和区域丧失（LOD）疝方面引入以来，其在侧腹壁的术前应用已得到广泛应用。术中筋膜牵引（IFT）是一种用于超过 10cm 宽度的复杂腹壁疝的成熟技术，也显示出了良好的效果。我们介绍了我们的单中心数据，包括 2019 年至 2023 年期间结合这两种技术治疗的 143 例连续病例。本研究的目的是为非常大且复杂的腹侧腹壁疝制定一种量身定制的方法。
我们在前瞻性维护的数据库中确定了 2019 年 8 月至 2023 年 12 月期间接受术前 BTA 和 IFT 治疗的连续患者，并进行了回顾性分析。指标包括术中发现和短期（30 天）术后结果。
我们的回顾性分析包括 143 例患者。平均年龄为 58.9 岁，所有患者中有 99%的美国麻醉医师协会（ASA）评分均为 II 级或 III 级，平均身体质量指数（BMI）为 32.4kg/m。BTA 和 IFT 后筋膜对筋膜的平均术中减少量为 9.81cm。14 例患者存在侧方缺损或中线和侧方疝的联合缺损。在 43 例患者中（30.1%）需要进行单侧或双侧腹横肌释放（TAR）。总体手术部位发生率（SSO）为 30.1%，其中 13.8%为手术部位感染（SSI）。如果进行额外的 TAR，则再次手术和 SSO 的发生率显著更高（均为 p=0.001；α=0.05）。
IFT 联合 BTA 是外科医生工具箱中具有变革性和经过临床验证的工具。在许多情况下，它可能是一种更简单、侵入性更小的替代方法，但不应将其视为治疗所有复杂 W3 疝的最终独立方法。
