Use of inj. Botox to the Abdominal Wall in Large Incisional Hernia Repair : A Local Experience in a Tertiary Hospital in Singapore

Large incisional hernias are challenging to manage even with techniques like Component Separation (CS). Although chemical component separation with botulinum toxin A (BTA) prior to surgical repair has gained popularity over the years, it still remains poorly described in Southeast Asian literature. We share our local experience using BTA as an adjunct prior to CS in the repair of a large 8 x 15 cm incisional hernia. 3 weeks before surgical repair of his hernia, 300 IU of BTA was injected over 3 sites of the lateral abdominal wall (LAW) muscles bilaterally. The patient subsequently underwent elective surgery and was discharged well on post operative day 5. A CT scan was done at 3 month showing no recurrence and sustained lengthening of his LAW muscles. In conclusion, low dose BTA increases LAW muscle length, facilitates fascial closure without tension as well as increasing abdominal cavity volume hence promoting better physiological postoperative adaptation. Despite being a useful adjunct in the management of large incisional hernias, there is significant variation in the dosage, concentration and techniques in which BTA is administered, as well as the optimal duration for administration prior to surgery. Further studies would have to be performed to obtain a consensus as to the best practice for the use of BTA.