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Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases

Background Obtaining primary fascial closure following laparostomy can be difficult; especially with fascial retraction or large pre-existing fascial defects. Various techniques have been described in the literature which attempt to improve reapproximation rates. Most techniques described comprise t...

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Autores principales: Laurens, Jason R, Foster, Amanda, Hardley, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059676/
https://www.ncbi.nlm.nih.gov/pubmed/33898149
http://dx.doi.org/10.7759/cureus.14066
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author Laurens, Jason R
Foster, Amanda
Hardley, Andrew
author_facet Laurens, Jason R
Foster, Amanda
Hardley, Andrew
author_sort Laurens, Jason R
collection PubMed
description Background Obtaining primary fascial closure following laparostomy can be difficult; especially with fascial retraction or large pre-existing fascial defects. Various techniques have been described in the literature which attempt to improve reapproximation rates. Most techniques described comprise the use of adjuncts including Bogota Bags, negative pressure dressings, anchor devices and various types of mesh. While most techniques achieve primary closure, less achieve primary fascial closure. Botulinum toxin A (BTA) has proven a beneficial adjunct in repairing large ventral herniae. While there is limited research in the use of BTA in the acute setting of laparostomy closure its benefits in elective repair may prove transferrable with the appropriate protocols. Method This retrospective study reviewed 12 cases where BTA was used as an adjunct to close laparostomy. It compared primary fascial closure rates to historical controls at the same institution.  Results Seven males and five females. Median age 63.5 years. Median BMI 32.95. Median days from BTA injection to primary fascial closure 9.5. Median 18 days from primary operation to primary fascial closure. 83% of patients achieved primary fascial closure with the rest achieving partial closure with the residual defect bridged with biological mesh. At the time of review, there was only one resulting ventral hernia in a patient with a BMI of 51.7 at the time of surgery. Conclusion While BTA does not guarantee primary fascial closure in laparostomy this study would indicate it improves primary fascial closure rates and can be added to any other existing method for managing the open abdomen. As BTA can be injected via the open abdomen or with ultrasound guidance it can be performed by any appropriately trained surgeon, anaesthetist or radiologist making its use widely achievable. Retrospectively registered.
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spelling pubmed-80596762021-04-23 Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases Laurens, Jason R Foster, Amanda Hardley, Andrew Cureus General Surgery Background Obtaining primary fascial closure following laparostomy can be difficult; especially with fascial retraction or large pre-existing fascial defects. Various techniques have been described in the literature which attempt to improve reapproximation rates. Most techniques described comprise the use of adjuncts including Bogota Bags, negative pressure dressings, anchor devices and various types of mesh. While most techniques achieve primary closure, less achieve primary fascial closure. Botulinum toxin A (BTA) has proven a beneficial adjunct in repairing large ventral herniae. While there is limited research in the use of BTA in the acute setting of laparostomy closure its benefits in elective repair may prove transferrable with the appropriate protocols. Method This retrospective study reviewed 12 cases where BTA was used as an adjunct to close laparostomy. It compared primary fascial closure rates to historical controls at the same institution.  Results Seven males and five females. Median age 63.5 years. Median BMI 32.95. Median days from BTA injection to primary fascial closure 9.5. Median 18 days from primary operation to primary fascial closure. 83% of patients achieved primary fascial closure with the rest achieving partial closure with the residual defect bridged with biological mesh. At the time of review, there was only one resulting ventral hernia in a patient with a BMI of 51.7 at the time of surgery. Conclusion While BTA does not guarantee primary fascial closure in laparostomy this study would indicate it improves primary fascial closure rates and can be added to any other existing method for managing the open abdomen. As BTA can be injected via the open abdomen or with ultrasound guidance it can be performed by any appropriately trained surgeon, anaesthetist or radiologist making its use widely achievable. Retrospectively registered. Cureus 2021-03-23 /pmc/articles/PMC8059676/ /pubmed/33898149 http://dx.doi.org/10.7759/cureus.14066 Text en Copyright © 2021, Laurens et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle General Surgery
Laurens, Jason R
Foster, Amanda
Hardley, Andrew
Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases
title Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases
title_full Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases
title_fullStr Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases
title_full_unstemmed Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases
title_short Closing Difficult Laparostomies With the Aid of Botulinum Toxin A: An Audit of 12 Cases
title_sort closing difficult laparostomies with the aid of botulinum toxin a: an audit of 12 cases
topic General Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059676/
https://www.ncbi.nlm.nih.gov/pubmed/33898149
http://dx.doi.org/10.7759/cureus.14066
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