AUTHOR=Giuffrida Mario , Biolchini Federico , Capelli Patrizio , Banchini Filippo , Perrone Gennaro 

TITLE=Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review

JOURNAL=Journal of Abdominal Wall Surgery

VOLUME=Volume 3 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2024.12650

DOI=10.3389/jaws.2024.12650

ISSN=2813-2092

ABSTRACT=Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias.This study aims to evaluate the efficacy and safety of combined use of PPP and BTX.Systematic electronic search, according to PRISMA criteria, was performed. A literature search of scientific papers was performed until December 2023. Articles were chosen based on reference to BTX and PPP in loss of domain ventral hernias with defect width more than 10 cm before surgery. GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of studies.The research included 7 articles, and 217 patients were analyzed. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days days before surgery.PPP complications were reported in 25.6% patients, Average reduction of volume of hernia (VH) / volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9-15%). Only 14.7% of the patients required TAR to repair loss of domain hernias.The SSI and SSO rate were 17.5% and 26.2%. No differences on SSI and SSO rate were found among different repair techniques.Recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (P<0.001).BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.