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Preoperative Botulinum Toxin A Injection (BTA) Vs Component Separation Techniques (CST) In Complex Abdominal Wall Reconstruction (AWR)- A Propensity-scored Matched Study
*Matthew Noel Marturano, *Sullivan Ayuso, *David Ku, *Robert Raible, *Robert Lopez, Keith Gersin, *Paul Colavita, *Vedra Augenstein, *Brant T Heniford
Atrium Health Carolinas Medical Center, Charlotte, NC

OBJECTIVE(S): Complete fascial closure significantly reduces recurrence rates and mesh complications in AWR. CST have been effective in closing large defects and those with large hernia volume (HV) but at the sacrifice of fascia and muscle and often increasing complication rates. Preoperative BTA has emerged as an adjunct to aid in fascial closure. Little data exist comparing pre-operative BTA versus CST, and our aim was to do so in a matched study.
METHODS: A prospective, single-center, hernia-specific database was queried and a 3:1 propensity matched study of patients undergoing AWR from 2016 to 2021 with BTA versus CST was performed based on BMI, defect width, hernia volume, and CDC wound classification. Demographics, operative characteristics, and outcomes were evaluated.
RESULTS: 35 BTA vs 105 CST matched patients were analyzed. There was no difference in age, gender, tobacco use, diabetes (all p>0.5), or number of previous hernia repairs (CST-5.38 vs BTA-5.47; p=0.76). Hernia defects were large (286.23cm2vs289.7cm2; p=0.73) as was HV (1498.3+2043.4cm3vs2914.7+6539.4cm3; p=0.35) and mesh size (836.67cm2vs911.06cm2; p=0.86). CDC wound classification (CDC3 and 4 - 39.1%vs40.0%; p=0.97), mesh choice (p=0.47), operative time (p=0.98), and concomitant panniculectomy (p=0.08) were equivalent, as was LOS (9.2 vs 7.1 days, p=0.26) and 30-day readmissions (6.8%vs0%, p=0.29). The BTA group had fewer surgical site occurrences (SSO) (32.4%vs11.4%; p=0.02) and surgical site infections (SSI) (11.7%vs0%; p=0.04). BTA patients underwent delayed primary closure (DPC) more frequently (15.2%vs34.3%; p=0.03). On multivariate analysis, BTA was independently associated with lower rates of SSO yet rates of SSI were not significant. Rates of abscess (5.7%vs2.9%; p=0.68), recurrence (2.9%vs0%; p=0.57), and median follow-up were similar (22.8+29.7vs9.8+12.7months; p=0.13). CST was more frequently performed in European Hernia Society (EHS) M1 hernias (21%vs2.9%; p=0.01), yet there was no difference in fascial closure, recurrence, or complications requiring intervention between the groups for M1-M5 hernias (all p>0.05).
CONCLUSIONS: In a matched study comparing patients with BTA versus CST, there was no difference in fascial closure rates or in hernia recurrence between the two groups. Pre-operative BTA can thereby achieve similar outcomes as CST while concurrently decreasing the frequency of SSO.


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