MTP1.10 Botulinum Toxin A for Large Midline Ventral/Incisional Hernias: Can we avoid an AWR

Aim Reconstruction of the linea alba is paramount for any large primary or recurrent ventral and incisional hernia repairs for restoration of the abdominal function that often requires an AWR (abdominal wall reconstruction) through EOR (external oblique release)/TAR (transversus abdominis release). We present here a case series where preoperative BTA obviated the need for an AWR. Patients and Method Retrospective analysis of a prospectively collected data of 6 patients that included demographics, ASA, BMI, symptoms, investigations, peri-operative details including complications and follow up of ventral/incisional hernias undergoing preoperative 300units BTA bilaterally to lateral abdominal muscles followed by repair within 4-6 weeks between June 23-August 24 in a large DGH. Results 3:3 M:F, age 65*(45-83) years, ASA II*(I-III), BMI 31*(27-34) with symptomatic 1 and 5 ventral and incisional hernias respectively; transverse defect 8.5*(6.3-12) cm. One had >20% loss of abdominal domain (LOD). Midline access, adhesiolysis, retro-rectus release allowed tension free closure of posterior (PRS) and anterior rectus sheath (ARS), with retro-rectus polypropylene mesh of cross-sectional area 368*(300-700) cm2 fixed to PRS and ARS (as required) with interrupted PDS. Skin closure after significant redundant tissue excision and negative wound vacuum dressing system. No complications, LOS 7 *(4-14) days and follow up 6*(0-15) months with uneventful recovery were recorded. Conclusion Early experience highlights benefit of BTA as an useful adjunct for complex abdominal wall hernia repairs with a good outcome that can avoid an AWR: a procedure associated with significant morbidity and even mortality.