Establishing a Chemical Component Relaxation Service Using Botulinum Toxin For Abdominal Wall Reconstruction: Single-Centre Experience From a UK Tertiary Hernia Referral Unit

Abstract

Background: Botulinum toxin type A (BTA) is a valuable adjunct in abdominal wall reconstruction (AWR). Chemical component relaxation (CCR) involves injecting BTA into the lateral abdominal wall, leading to muscle paralysis and elongation which facilitates primary fascial closure during surgery without the need for extensive dissection. There are currently no standardised protocols for BTA administration in the perioperative period for AWR. We present a standardised protocol for CCR from our tertiary hernia unit and report our outcomes following surgery. Methods: A retrospective analysis of a prospective dataset of all patients undergoing standardised pre-operative CCR between 1st May 2021 and 30th April 2024 for AWR were included in this study. Analysis of pre-operative multi-disciplinary team (MDT) planning, BTA administration, surgical procedure and outcomes were performed. Results: During the 3-year-period, 35 patients underwent CCR with subsequent AWR. The median age was 58 and median BMI was 32. Median hernia defect width was 8cm. Anterior and posterior sheath closure was achieved in 91% of cases. In total, 39% with defect size >8cm did not require component separation and were considered "downstaged". There were no complications following CCR, and the surgical site occurrence rate following AWR was 26%. Hernia recurrence occurred in 1 patient. Conclusions: The presented protocol of pre-operative BTA appears to be a safe method of CCR. We demonstrate that its use may reduce the need for component separation and is associated with good post-operative outcomes.