Fascial closure in giant ventral hernias after preoperative
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
This study states that preoperative progressive pneumoperitoneum and Botulinum Toxin A can facilitate fascial closure without causing major adverse events.

The primary objective of this study by the journal Surgery was to assess the perioperative efficacy of the preoperative use of progressive pneumoperitoneum or Botulinum Toxin A injections in ventral hernia repair.

Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar were systematically searched. Studies in English reporting on fascial closure, indications, complications or postoperative outcomes in adult patients that had undergone progressive pneumoperitoneum, Botulinum Toxin A injections, or both before ventral hernia repair were included. Study quality was assessed with the Oxford Levels of Evidence guidelines and the Methodological Index for Non-Randomized Studies criteria. A pooled fascial closure rate and recurrence rate were calculated with random effects models.

20 studies were included from the 905 identified, comprising the use progressive pneumoperitoneum, Botulinum Toxin A, and both techniques.

--The overall fascial closure rate was 0.94. Indications for the use of progressive pneumoperitoneum or Botulinum Toxin A were based on objective or subjective measures.

--In contrast to the use of Botulinum Toxin A, reported complications with the use of progressive pneumoperitoneum were ample and sometimes severe.

--The cumulative reported recurrence rate was 0.03.

In conclusion, preoperative progressive pneumoperitoneum and Botulinum Toxin A can facilitate fascial closure without causing significant numbers of adverse events. Botulinum Toxin A qualifies for low-threshold use, yet progressive pneumoperitoneum should be used cautiously owing to a larger number of complications.

Source: https://doi.org/10.1016/j.surg.2021.03.027
Like
Comment
Share