Prevention of Component Separation in Complex Abdominal Wall Surgery by Botox Prehabilitation: A Propensity-Matched Study

Aim To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and decrease the necessity of myofascial release. This can be accomplished by administration of Botulinum Toxin Type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the necessity to perform CST in patients with complex abdominal wall hernias. Methods Patients with a complex abdominal wall hernia, planned to undergo CST by myofascial release (MFR) between July 2020 and November 2022 were included. Outcome of procedures with 300U BTA 4[2–6] weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Muscle length was assessed by CT and operative details were included. Results 13 patients with a median hernia width of 12 cm (IQR 9–14, range 24) were prehabilitated with BTA between July 2020 and November 2022. An MFR was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring MFR. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for MFR was observed. Conclusion There is a tendency for decrease of necessity for MFR by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.