[The use of botulinum toxin in hernia surgery: results of a survey in certified hernia centers].

Chirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI:10.1007/s00104-024-02121-x
Sebastian Schaaf, Aliona Wöhler, Patricia Gerlach, Arnulf G Willms, Robert Schwab
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Abstract

Background: Botulinum toxin application into the abdominal wall prior to major hernia repair can reduce the complexity of surgery and has been increasingly used in recent years, even if it is an off-label use.

Objective: To what extent is botulinum toxin used in hernia surgery in German-speaking countries and what is the current evidence in the literature?

Material and methods: In a voluntary online survey of German Society for General and Visceral Surgery (DGAV)-certified competence centers and reference centers for hernia surgery, aspects of botulinum toxin application were surveyed and the results analyzed.

Results: A total of 57 centers took part in the survey, of which 27 (47%) use botulinum toxin. The main reasons for not using it were lack of experience and reimbursement. Of the centers 85% have treated less than 50 patients with botulinum toxin. The main indications were midline hernias (M2-4 according to the EHS classification) with a hernia gap > 10 cm (W3 according to EHS classification) and loss of domain situations. The application was predominantly ultrasound-guided by designated hernia surgeons with 100-200 Allergan or 500 Speywood units 4-6 weeks preoperatively and without complications related to the botulinum toxin application.

Conclusion: Botulinum toxin injections in hernia surgery appear to be safe and effective. Ultrasound-guided preoperative bilateral administration is supported by the available data. Specific course and information formats should be offered by the hernia surgery institutions.

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[疝气手术中肉毒素的使用:认证疝气中心的调查结果]。
背景:在疝气修补术前将肉毒杆菌毒素应用于腹壁可降低手术的复杂性,近年来,即使是标签外使用,也越来越多地使用肉毒杆菌毒素:目的:在德语国家,肉毒杆菌毒素在疝气手术中的应用程度如何,目前的文献证据如何?对德国普通与内脏外科学会(DGAV)认证的疝气手术能力中心和参考中心进行自愿在线调查,调查肉毒杆菌毒素应用的各个方面,并对结果进行分析:共有 57 家中心参与了调查,其中 27 家(47%)使用了肉毒杆菌毒素。不使用的主要原因是缺乏经验和报销问题。85%的中心使用肉毒杆菌毒素治疗过不到50名患者。主要适应症是疝气间隙大于 10 厘米(根据 EHS 分类为 W3)的中线疝气(根据 EHS 分类为 M2-4)和疝气域缺失情况。肉毒素注射主要由指定的疝外科医生在超声波引导下进行,术前4-6周注射100-200 Allergan或500 Speywood单位,没有出现与肉毒素注射相关的并发症:结论:在疝气手术中注射肉毒杆菌毒素似乎是安全有效的。现有数据支持在超声引导下进行术前双侧注射。疝气手术机构应提供具体的课程和信息形式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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