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. 2023 Apr;27(2):281-291.
doi: 10.1007/s10029-022-02692-w. Epub 2022 Oct 14.

A computed tomography study investigating the effects of botulinum toxin injections prior to complex abdominal wall reconstruction

J J M Claessen  1 , A S Timmer  1 , R Hemke  2 , J J Atema  1 , R Hompes  1 , M A Boermeester #  3   4 , M V H Rutten #  5
Affiliations

A computed tomography study investigating the effects of botulinum toxin injections prior to complex abdominal wall reconstruction

J J M Claessen et al. Hernia. 2023 Apr.

Abstract

Objective: To explore how intramuscular injection of botulinum toxin A (BTA) affects the lateral abdominal wall (LAW) musculature, abdominal- and hernia dimensions, and muscle structure on computed tomography (CT) in patients scheduled for complex abdominal wall reconstruction (CAWR).

Methods: Retrospective analysis of prospectively registered patients who received bilateral intramuscular BTA injections into all three muscles of the LAW. Only patients for which a CT was available before and 3-6 weeks after BTA treatment prior to surgery were analyzed.

Results: Fifty-two patients were analyzed. Median hernia width in all patients decreased with 0.4 cm (IQR - 2.1;0.6) (p = 0.023). Median intra-abdominal transverse diameter increased with 0.9 cm (IQR - 0.2;3.3) (p = 0.001) and the intra-abdominal anterior-posterior diameter decreased with 0.5 cm (IQR - 1.3;0.5) (p = 0.017), making the abdomen more oval. Median LAW muscle length increased with 0.9 cm (IQR 0.0;2.4) per side (p < 0.001), muscle thickness decreased with 0.5 cm (IQR - 0.8;- 0.2) (- 25.0%) per side (p < 0.001), and muscle mass decreased with 3.9 cm2 (IQR - 6.4;-1.5) (- 15.8%) per side (p < 0.001). Median HU of the psoas muscles (density) increased with 4.8 HU (IQR 0.4;9.7) (10.3%) per side (p < 0.001). Effects of BTA were more pronounced in patients with a loss of domain (LoD) ≥ 20%.

Conclusions: The main effect of BTA injections is elongation and thinning of the LAW muscles, more than a decrease in hernia width. Concomitantly, the abdomen becomes more oval. An increase of psoas muscles density is seen, associated with offloading of the LAW muscles. Patients with large LoD have a proportionally higher effect of BTA.

Keywords: Botulinum toxin A; CAWR; CT scan.

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Conflict of interest statement

Jeroen J. M. Claessen, Allard S. Timmer, Robert Hemke, Jasper J. Atema, R. Hompes, and Martin V. H. Rutten declare that there is no conflict of interest. Marja A. Boermeester reported receiving institutional grants from J and J/Ethicon, KCI/3 M, and New Compliance; and being a speaker, advisor, and/or instructor for KCI/3 M, J and J/Ethicon, BD Bard, Gore, GD Medical, Medtronic, TELABio, Molnlycke, and Smith and Nephew. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Measurements. A hernia width (yellow line), intra-abdominal width (purple line), and intra-abdominal depth (green line); B LAW muscle length (yellow line) and LAW muscle thickness (green line); C LAW muscle mass and density, and psoas muscle mass and density; D The intra-abdominal volumes and hernia volumes were obtained by encircling the intra-abdominal (red) and hernia (yellow) surfaces on all axial CT slides from the diaphragm to the pelvis. Then, the segmentation tool calculated the volumes. Loss of domain was calculated according to the Sabbagh method (hernia volume/(hernia- + abdominal volume)). LAW lateral abdominal wall
Fig. 2
Fig. 2
Box plots of the differences between median pre- and post-injection measures (gold boxplots) and individual relative changes compared to pre-BTA (blue boxplots): A hernia width, abdominal width and -depth, and LAW length and -thickness, B LAW muscle mass, C LAW muscle density and psoas muscle density, and D loss of domain. The boxes indicate median and interquartile range. The transverse line is de zero-line. LAW lateral abdominal wall, LoD loss of domain, HU Hounsfield units
Fig. 3
Fig. 3
An example of showing optimal effects of pre- and post-BTA treatment, although such effects were not observed in all patients. A Hernia width (white line) and abdominal width (purple line) and abdominal depth (green line), B LAW muscle length (yellow line) and LAW muscle thickness (green line), and C LAW muscle mass and LAW muscle density. D Psoas muscle density. LAW lateral abdominal wall
See this image and copyright information in PMC

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