The Impact of Botulinum Toxin a Application on Reducing the Necessity for "Component Separation Techniques" in Giant Abdominal Hernias: A Dual-Center, Polish-Ukrainian, Retrospective Cohort Study

Introduction Abdominal hernias are a common post-laparotomy complication, with a significant number of cases evolving into giant hernias, challenging the effectiveness of traditional surgical approaches. Component separation techniques (CST), while popular, come with several drawbacks, including irreversible anatomical alterations and increased perioperative trauma. The preoperative use of Botulinum Toxin A (BTA) has emerged as a promising alternative, potentially reducing the necessity for CST by temporarily paralyzing and elongating the lateral abdominal muscles, thus facilitating hernial defect closure. Materials and Methods This cohort study compared two groups of patients undergoing elective surgery for giant abdominal hernias (W3 according to the European Hernia Society classification) between 2022 and 2023 at two reference centers located in Gdansk (Poland) and Lviv (Ukraine). The NON-BOTOX group (n = 50) underwent traditional surgery, while the BOTOX group received preoperative BTA injections (n = 50). The primary outcome measured was the necessity of performing CST for anterior abdominal wall closure. Complications such as surgical site infections (SSI), seroma, and hematoma were also evaluated. Results Preliminary findings suggest that the preoperative application of BTA significantly reduces the need for CST in patients with giant abdominal hernias with a notable decrease in CST necessity by 38%. The groups were comparable in demographics and hernia specifics, allowing a fair comparison of surgical outcomes and complication rates. Conclusions Preoperative BTA application appears to be an effective strategy to decrease the reliance on CST in the treatment of giant abdominal hernias, potentially leading to simpler surgical procedures, reduced anatomical disruption, and a decrease in perioperative complications. However, during the study, two individuals reported respiratory efficiency issues following BTA administration. This observation has inspired the authors to continue their research and verify whether BTA administration benefits all patient groups equally. Further investigations are crucial to ensure the safety and efficacy of BTA use in preoperative preparation for patients with complex abdominal hernias.