Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation

Background: Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra"corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre"operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. Methods: A single"centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non"midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200-300"‰units Botox) 4-6"‰weeks prior to surgery. Repairs were mesh"reinforced following fascial closure. Results: Twelve (10 female, two male) patients, with a median age 72"‰years (range 31-83) and body mass index of 27.3 kg/m2 (range 22.8-61.7) were included. The median length of operation was 133"‰min (range 45-290) and length of hospital stay 3"‰days (range 1-28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital"acquired pneumonia and pseudomembranous colitis. Conclusion: Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non"midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.