Effect of preoperative botulinum toxin injection in the treatment of giant incisional hernias: a systematic review and meta-analysis.

Abstract

<h4>Introduction</h4>Giant incisional hernias pose a significant surgical challenge due to their high morbidity, risk of postoperative complications, and recurrence. Preoperative botulinum toxin type A (BTX-A) injection has emerged as a novel intervention to optimize fascial closure by reducing abdominal wall muscle tension, facilitating surgical repair, and potentially decreasing postoperative complications.<h4>Objective</h4>To evaluate the effect of preoperative BTX-A injection on fascial closure rates, postoperative complications, hernia recurrence, and hospital length of stay in patients undergoing repair of giant incisional hernias.<h4>Methods</h4>A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies assessing the outcomes of BTX-A injection in the management of giant incisional hernias were included. The primary outcomes were the rate of complete fascial closure and hernia recurrence. Secondary outcomes included postoperative complications and length of hospital stay. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.<h4>Results</h4>Five articles were selected and included in this systematic review. BTX-A injections showed a positive trend toward improved fascial closure in certain studies, although global analysis did not reveal statistically significant differences compared to controls (RR = 0.95; 95% CI: 0.90-1.01). There was no significant effect on hernia recurrence (RR = 1.02; 95% CI: 0.64-1.49). However, BTX-A significantly reduced postoperative complications (RR = 0.66; 95% CI: 0.50-0.88), with no meaningful reduction in the length of hospital stay (MD = -0.72 days; 95% CI: -1.8 to 0.36).<h4>Conclusion</h4>Preoperative BTX-A injection is a safe adjunct but has not shown significant benefits in improving fascial closure or reducing hernia recurrence. Although it reduces postoperative complications, its overall clinical impact is limited. Current evidence does not support its routine use, and further high-quality RCTs are needed.