BHSo1 Establishing a chemical component separation service using botulinum toxin for abdominal wall reconstruction in a district general tertiary hernia referral unit
Oliver Curwen, Sarah Zhao, Rebecca Ludden, Emilio Schweighart Gate, Ravishankar Jakkalasaibaba, Samuel Parker, Rhys ThomasAbstract
Background
Botulinum toxin type A (BTA) is a valuable adjunct in abdominal wall reconstruction (AWR). Chemical component separation (CCS) involves injecting BTA into the lateral abdominal wall, leading to muscle relaxation and elongation. The aim is to achieve primary fascial closure of both anterior and posterior sheaths without the need for extensive dissection, associated with greater morbidity.
Aim
To present a standardised protocol for CCS in a tertiary hernia unit and to demonstrate the clinical benefit of BTA in AWR.
Methods
A retrospective analysis of a prospective dataset of all patients undergoing standardised pre-operative CCS between May 2021 and May 2024 for AWR were included in this study. Analysis of pre-operative multi-disciplinary team (MDT) planning, BTA administration, surgical procedure and outcomes was performed.
Results
During the 3-year-period, 45 patients underwent CCS in a standardised protocol with subsequent AWR, 4 were out of area referrals. The median age was 60, with a male:female of 2:3, median BMI was 32.1. Average hernia defect width was 8.7 cm. 23 patients underwent synthetic mesh repair and 20 had biosynthetic mesh repair. Anterior and posterior sheath closure was achieved in 84% of cases, with 36% avoiding the need for component separation. There were no complications following CCS, and the complication rate following AWR was 38%, including seroma (16%). Parastomal recurrence occurred in 2 patients.
Conclusions
The presented protocol of pre-operative BTA is a safe method of CCS. We demonstrate that its use reduces the need for extensive component dissection and is associated with good post-operative outcomes.