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Meta-Analysis
. 2021 Dec;25(6):1413-1425.
doi: 10.1007/s10029-021-02499-1. Epub 2021 Sep 21.

A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction

A S Timmer  1 , J J M Claessen  1 , J J Atema  1 , M V H Rutten  2 , R Hompes  1 , M A Boermeester  3
Affiliations
Meta-Analysis

A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction

A S Timmer et al. Hernia. 2021 Dec.

Abstract

Purpose: To systematically review technical aspects and treatment regimens of botulinum toxin A (BTA) injections in the lateral abdominal wall musculature. We also investigated the effect of BTA on abdominal muscle- and hernia dimensions, and clinical outcome.

Methods: PubMed, EMBASE, CENTRAL, and CINAHL were searched for studies that investigate the injection of BTA in the lateral abdominal wall muscles. Study characteristics, BTA treatment regimens, surgical procedures, and clinical outcomes are presented descriptively. The effect of BTA on muscle- and hernia dimensions is analyzed using random-effects meta-analyses, and exclusively for studies that investigate ventral incisional hernia patients.

Results: We identified 23 studies, comprising 995 patients. Generally, either 500 units of Dysport® or 200-300 units of Botox® are injected at 3-5 locations bilaterally in all three muscles of the lateral abdominal wall, about 4 weeks prior to surgery. No major procedural complications are reported. Meta-analyses show that BTA provides significant elongation of the lateral abdominal wall of 3.2 cm per side (95% CI 2.0-4.3, I2 = 0%, p < 0.001); 6.3 cm total elongation, and a significant but heterogeneous decrease in transverse hernia width (95% CI 0.2-6.8, I2 = 94%, p = 0.04). Furthermore, meta-analysis shows that BTA pretreatment in ventral hernia patients significantly increases the fascial closure rate [RR 1.08 (95% CI 1.02-1.16, I2 = 0%, p = 0.02)].

Conclusion: The injection technique and treatment regimens of botulinum toxin A as well as patient selection require standardization. Bilateral pretreatment in hernia patients significantly elongates the lateral abdominal wall muscles, making fascial closure during surgical hernia repair more likely.

Study registration: A review protocol for this meta-analysis was registered at PROSPERO (CRD42020198246).

Keywords: Abdominal wall reconstruction; Botulinum toxin A; Ventral hernia.

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Conflict of interest statement

Allard S. Timmer, Jeroen J.M. Claessen, Jasper J. Atema, Martin V.H. Rutten, and Roel Hompes declare no conflict of interest. Marja A. Boermeester reports receiving institutional grants from J&J/Ethicon, KCI/3M, and New Compliance; and is an advisory board member and/or speaker and/or instructor for KCI/3M, J&J/Ethicon, Allergan, BD Bard, Gore, TelaBIO, GD Medical, Medtronic, and Smith & Nephew.

Figures

Fig. 1
Fig. 1
PRISMA systematic review flow diagram
Fig. 2
Fig. 2
Forest plot of the difference in length of the lateral abdominal wall muscles in centimeters before and after BTA (without PPP). 2.1.1 right-ride muscles, 2.1.2 left-side muscles
Fig. 3
Fig. 3
Forest plot of the difference in transverse hernia defect width in centimeters before and after BTA (without PPP). From the study by Ibarra-Hurtado et al. [7], only the patients in which CT imaging is used to measure abdominal wall defects are analyzed
Fig. 4
Fig. 4
Forest plot of studies that directly compare fascial closure rate between patients with and without BTA pretreatment. Studies that combine the use of BTA and PPP are not included
See this image and copyright information in PMC

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