SP 7.2.7- Role of Pre-Operative Chemical Component Separation(Botox) in Abdominal Wall Reconstruction
Published Date: 01st September 2019
Publication Authors: Singh S, Atherton P, Samad A, Ross S, Benson A, Scott M
Aim
It is accepted that CCS (Botulinum toxin A, BOTOX) is a useful pre-operative tool to enable successful AWR. UsuallyBOTOXis used in selected complex cases.We propose the routine use of CCS in allmidline defects of more than 5 cm size. To evaluate the outcome of pre-operative US guided injection of BOTOX in all abdominal wall reconstructions.
Method(s)
Between November 2014 - 2018, 190 patients underwent abdominal wall reconstruction for defects of >50 mm and VHWG grade of > 2. 126 (66%) patients received pre-operative US guided BOTOX injection (200 IU)). Prospective database was analysed for outcome.
Result(s)
Median age of patients received BOTOX was 55. Median BMI was 30 and female: male ratio was 1.7:1.Median size of defect was 62 mm. 33% defects were associated with diastasis of recti. Only 10% of patients required surgical component separation to achieve satisfactory reconstruction. Median operative time was 3 hours. Median hospital stays was 4 days. 6 patients (4.8%) required HDU admission. Abdominoplasty approach was used in 47% whereas 46% defects were repaired with midline incision. Bio-synthetic (PHASIX) mesh was used in 83% patient. Post-operative complication rate was 25%. Mortality rate was 0.8%. CCS rate increased from 11% in 2016 to 86%in 2018.
Conclusion(s)
Botox given in the pre-operative period reduces the requirement of surgical Component separation to achieve satisfactory reconstruction. CCS also reduces the length of hospital stay. Based on the above results we recommend that CCS should routinely perform in every abdominal wall reconstruction.
Singh, S; Atherton, P; Samad, A; Ross, S; Benson, A; Scott, MH. (2019). SP 7.2.7- Role of Pre-Operative Chemical Component Separation(Botox) in Abdominal Wall Reconstruction. British Journal of Surgery. 106 (S5), 33.