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.

Authors

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

Published in

Hernia : the journal of hernias and abdominal wall surgery. Volume 29. Issue 1. Pages 171. May 23, 2025. Epub May 23, 2025.

Abstract

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.
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.
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).
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.

PMID:
40407928
Bibliographic data and abstract were imported from PubMed on 23 May 2025.

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