Jahangiri Younes, Goldsmith Dylan, Banks-Venegoni Amy, Fritz Gregory, Zambito Giuseppe, Jiao Albert, King Lane, Castle Jordan, Quasem Khaleel, Morrison James
Division of Interventional Radiology, Corewell Health West Michigan, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA.
Department of Radiology, Michigan State University, East Lansing, MI, USA.
Hernia. 2025 May 23;29(1):171. doi: 10.1007/s10029-025-03369-w.
To evaluate the effectiveness of chemical component separation (CCS) via computed tomography (CT)-guided intramuscular injection of OnabotulinumtoxinA (Botox) in postoperative recurrence of large complex incisional ventral abdominal hernias.
A total of 97 patients with large ventral abdominal hernias who underwent complex hernia repair between November 2017 and October 2021 after (n = 37) (Botox) or without (n = 60) Botox injection (no-Botox) were included in the study. Data were summarized as median [min-max] or frequency (%) and analyzed using the Fisher's exact test, Mann-Whitney U test, multivariate logistic regression with backward stepwise selection of covariates and augmented inverse probability-weighted analysis with Stata BE 18.0 at a significance level set at 0.10.
There was no statistically significant difference between Botox and no-Botox groups in patients' age (64[34-78] vs. 62[24-94], p = 0.885), sex (females: 46% vs. 55%, p = 0.410), body mass index (BMI) (32[19-53] vs. 31[18-50], p = 0.431) and hernia volume (3197[226-24232] vs. 2366[140-24314], p = 0.458). Median follow-up duration was 38[2-72] months in Botox and 48[6-81] months in no-Botox groups (p = 0.010), and all-time hernia recurrence was 8% in Botox and 22% in no-Botox groups, respectively (p = 0.097). In multivariate regression analysis, CCS, hernia volume, implanted mesh type and overall postoperative complications were associated with hernia recurrence. After propensity score weighting for follow-up duration, surgical component separation and postoperative discharge destination, CCS was associated with 71% reduced risk of hernia recurrence (p = 0.045).
The results of this study suggests that CT-guided chemical component separation with intramuscular injection of OnabotulinumtoxinA may be effective in reducing the risk of post-surgical recurrence of large complex incisional ventral abdominal hernias.
评估计算机断层扫描（CT）引导下肌肉注射A型肉毒毒素（保妥适）进行化学成分分离（CCS）对大型复杂切口性腹直肌旁疝术后复发的有效性。
本研究纳入了97例大型腹直肌旁疝患者，这些患者在2017年11月至2021年10月期间接受了复杂疝修补术，其中37例注射了（保妥适）（Botox组），60例未注射（非Botox组）。数据总结为中位数[最小值 - 最大值]或频率（%），并使用Fisher精确检验、Mann-Whitney U检验、协变量向后逐步选择的多因素逻辑回归以及使用Stata BE 18.0进行的增强逆概率加权分析进行分析，显著性水平设定为0.10。
Botox组和非Botox组在患者年龄（64[34 - 78] vs. 62[24 - 94]，p = 0.885）、性别（女性：46% vs. 55%，p = 0.410）、体重指数（BMI）（32[19 - 53] vs. 31[18 - 50]，p = 0.431）和疝体积（3197[226 - 24232] vs. 2366[140 - 24314]，p = 0.458）方面无统计学显著差异。Botox组的中位随访时间为38[2 - 72]个月，非Botox组为48[6 - 81]个月（p = 0.010），总体疝复发率在Botox组为8%，在非Botox组为22%（p = 0.097）。在多因素回归分析中，CCS、疝体积、植入补片类型和总体术后并发症与疝复发相关。在对随访时间、手术成分分离和术后出院目的地进行倾向评分加权后，CCS与疝复发风险降低71%相关（p = 0.045）。
本研究结果表明，CT引导下肌肉注射A型肉毒毒素进行化学成分分离可能有效降低大型复杂切口性腹直肌旁疝术后复发的风险。
