[Botulinum toxin type A reducing extent of TAR procedure in patients with large postoperative hernias].

[OBJECTIVE] To assess the feasibility of reducing the extent of TAR repair in patients with W3 postoperative ventral hernias through preliminary BTA injections into lateral abdominal muscles.

[MATERIAL AND METHODS] The study included 47 patients with midline POVH classified as W3. Eleven patients (group 1) received injections of BTA 500 U four weeks prior to scheduled unilateral TAR procedure. Group 2 (=36) underwent standard bilateral TAR without BTA injections. Group 1 was characterized by significantly higher ASA class (=0.011), Tanaka index (0.23±0.01 vs. 0.19±0.02; =0.001) and fascial defect width (16.8 cm vs. 15.3 cm; =0.01) and length (18 cm vs. 14 cm; =0.005). Both groups were comparable in other parameters.

[RESULTS] After BTA administration, fascial defect width reduced from 16.8 to 12.96 cm (<0.001) and Tanaka index reduced from 0.23 to 0.21 (=0.002) in group 1. Unilateral TAR was successfully performed in 72.7% of patients. Group 1 demonstrated significantly shorter surgery time (158.1±11.0 vs. 287.8±87.0 min; <0.001) and hospital-stay (4 vs. 8 days; =0.02) with comparable rate of severe complications. No between-group differences in quality of life were observed after 6 months (=0.596).

[CONCLUSION] Preoperative BTA administration in patients with large midline POVH allows for less extent of TAR repair.