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Purpose <p>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.</p> Materials and methods <p>A total of 97 patients with large ventral abdominal hernias who underwent complex hernia repair between November 2017 and October 2021 after (<i>n</i> = 37) (Botox) or without (<i>n</i> = 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.</p> Results <p>There was no statistically significant difference between Botox and no-Botox groups in patients’ age (64[34–78] vs. 62[24–94], <i>p</i> = 0.885), sex (females: 46% vs. 55%, <i>p</i> = 0.410), body mass index (BMI) (32[19–53] vs. 31[18–50], <i>p</i> = 0.431) and hernia volume (3197[226–24232] vs. 2366[140–24314], <i>p</i> = 0.458). Median follow-up duration was 38[2–72] months in Botox and 48[6–81] months in no-Botox groups (<i>p</i> = 0.010), and all-time hernia recurrence was 8% in Botox and 22% in no-Botox groups, respectively (<i>p</i> = 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 (<i>p</i> = 0.045).</p> Conclusion <p>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.</p>

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Effectiveness of pre-operative chemical component separation with computed tomography-guided intramuscular injection of OnabotulinumtoxinA in outcomes of large complex incisional ventral abdominal hernia repair: a propensity score-weighted comparative analysis

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  • 发表日期：

    2025年5月23日

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  • Younes Jahangiri,
  • Dylan Goldsmith,
  • Amy Banks-Venegoni,
  • Gregory Fritz,
  • Giuseppe Zambito,
  • Albert Jiao,
  • Lane King,
  • Jordan Castle,
  • Khaleel Quasem,
  • James Morrison

摘要

Purpose

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.

Materials and methods

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.

Results

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).

Conclusion

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.