Scholarlink

Purpose <p>The purpose of the current paper is to propose standardized indications and practical protocols for the use of Botulinum Toxin A (BTA) and Preoperative Progressive Pneumoperitoneum (PPP) in the management of LOD incisional hernia.</p> Methods <p>A retrospective observational study at a tertiary care hospital in a developing country analyzed 29 patients with LOD incisional hernia (Tanaka Index &gt; 0.25) from June 2019 to June 2025. Patients underwent BTA administration four weeks preoperatively, with PPP added for those with Tanaka Index &gt; 0.35. Preoperative CT imaging assessed hernia sac and abdominal cavity volumes. Surgical repair utilized the Madrid modification of Posterior Component Separation with Transversus Abdominis Release and Fleur-de-lis abdominoplasty. Outcomes included Tanaka Index changes, fascial closure success, complications (Clavien-Dindo classification), and recurrence rates.</p> Results <p>The mean Tanaka Index significantly decreased from 0.39 ± 0.06 to 0.19 ± 0.02 (<i>p</i> &lt; 0.0001), and the mean hernia defect width reduced from 16.13 ± 2.27&#xa0;cm to 8.36 ± 1.15&#xa0;cm (<i>p</i> &lt; 0.0001). Fascial closure was achieved in all patients. Postoperative complications included one case of reactionary hemorrhage (3.45%), three superficial surgical site infections (10.34%), two cases of basal atelectasis (6.89%), and two minor seromas (6.89%). Only one recurrence (3.45%) was observed during a median follow-up of four years. One patient (7.6%) undergoing PPP reported transient shoulder tip pain.</p> Conclusion <p>A protocol-driven approach using BTA and selective PPP effectively reduces hernia dimensions, enables tension-free fascial closure, and minimizes complications in LOD incisional hernia repair, offering a viable strategy in resource-constrained settings.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Loss of domain incisional hernia: challenges simplified by standardizing the use of botulinum toxin A and preoperative progressive pneumoperitoneum

  • 期刊论文

  • 发表日期：

    2026年2月7日

查看全文
  • Arshad Rashid,
  • Abdul Hamid Samoon,
  • Rajandeep Singh Bali,
  • Obaid Ashraf,
  • Iqbal Saleem Mir,
  • Khushdil Ajaz,
  • Haris Khursheed

摘要

Purpose

The purpose of the current paper is to propose standardized indications and practical protocols for the use of Botulinum Toxin A (BTA) and Preoperative Progressive Pneumoperitoneum (PPP) in the management of LOD incisional hernia.

Methods

A retrospective observational study at a tertiary care hospital in a developing country analyzed 29 patients with LOD incisional hernia (Tanaka Index > 0.25) from June 2019 to June 2025. Patients underwent BTA administration four weeks preoperatively, with PPP added for those with Tanaka Index > 0.35. Preoperative CT imaging assessed hernia sac and abdominal cavity volumes. Surgical repair utilized the Madrid modification of Posterior Component Separation with Transversus Abdominis Release and Fleur-de-lis abdominoplasty. Outcomes included Tanaka Index changes, fascial closure success, complications (Clavien-Dindo classification), and recurrence rates.

Results

The mean Tanaka Index significantly decreased from 0.39 ± 0.06 to 0.19 ± 0.02 (p < 0.0001), and the mean hernia defect width reduced from 16.13 ± 2.27 cm to 8.36 ± 1.15 cm (p < 0.0001). Fascial closure was achieved in all patients. Postoperative complications included one case of reactionary hemorrhage (3.45%), three superficial surgical site infections (10.34%), two cases of basal atelectasis (6.89%), and two minor seromas (6.89%). Only one recurrence (3.45%) was observed during a median follow-up of four years. One patient (7.6%) undergoing PPP reported transient shoulder tip pain.

Conclusion

A protocol-driven approach using BTA and selective PPP effectively reduces hernia dimensions, enables tension-free fascial closure, and minimizes complications in LOD incisional hernia repair, offering a viable strategy in resource-constrained settings.