TY - JOUR
T1 - Fascial closure in giant ventral hernias after preoperative botulinum toxin a and progressive pneumoperitoneum
T2 - A systematic review and meta-analysis
AU - van Rooijen, Mathilde Maria Johanna
AU - Yurtkap, Yagmur
AU - Allaeys, Mathias
AU - Ibrahim, Nabeel
AU - Berrevoet, Frederik
AU - Lange, Johan F.
N1 - Funding Information:
The authors wish to thank Sabrina Meertens-Gunput and Wichor Bramer from the Erasmus MC Medical Library for developing and updating the search strategies.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: The primary objective was to assess the perioperative efficacy of the preoperative use of progressive pneumoperitoneum or Botulinum Toxin A injections in ventral hernia repair. Methods: Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar were systematically searched. Studies in English reporting on fascial closure, indications, complications or postoperative outcomes in adult patients that had undergone progressive pneumoperitoneum, Botulinum Toxin A injections, or both before ventral hernia repair were included. Study quality was assessed with the Oxford Levels of Evidence guidelines and the Methodological Index for Non-Randomized Studies criteria. A pooled fascial closure rate and recurrence rate were calculated with random effects models. Results: Twenty studies were included from the 905 identified, comprising the use progressive pneumoperitoneum (n = 11), Botulinum Toxin A (n = 6), and both techniques (n = 3). The overall fascial closure rate was 0.94 (95% confidence interval 0.89–0.98). Indications for the use of progressive pneumoperitoneum or Botulinum Toxin A were based on objective (eg, computed tomography measurements) or subjective measures (eg, foreseen surgical problems). In contrast to the use of Botulinum Toxin A, reported complications with the use of progressive pneumoperitoneum were ample and sometimes severe. The cumulative reported recurrence rate was 0.03 (95% confidence interval 0.01–0.06). Conclusion: Preoperative progressive pneumoperitoneum and Botulinum Toxin A can facilitate fascial closure without causing significant numbers of adverse events. Botulinum Toxin A qualifies for low-threshold use, yet progressive pneumoperitoneum should be used cautiously owing to a larger number of complications. Definitive recommendations cannot be made as the quality of included studies is low, bias is present, and comparative information is scarce. Registration number Information about the design and conduct of this systematic review has been registered on PROSPERO, registration number CRD42020181679.
AB - Background: The primary objective was to assess the perioperative efficacy of the preoperative use of progressive pneumoperitoneum or Botulinum Toxin A injections in ventral hernia repair. Methods: Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar were systematically searched. Studies in English reporting on fascial closure, indications, complications or postoperative outcomes in adult patients that had undergone progressive pneumoperitoneum, Botulinum Toxin A injections, or both before ventral hernia repair were included. Study quality was assessed with the Oxford Levels of Evidence guidelines and the Methodological Index for Non-Randomized Studies criteria. A pooled fascial closure rate and recurrence rate were calculated with random effects models. Results: Twenty studies were included from the 905 identified, comprising the use progressive pneumoperitoneum (n = 11), Botulinum Toxin A (n = 6), and both techniques (n = 3). The overall fascial closure rate was 0.94 (95% confidence interval 0.89–0.98). Indications for the use of progressive pneumoperitoneum or Botulinum Toxin A were based on objective (eg, computed tomography measurements) or subjective measures (eg, foreseen surgical problems). In contrast to the use of Botulinum Toxin A, reported complications with the use of progressive pneumoperitoneum were ample and sometimes severe. The cumulative reported recurrence rate was 0.03 (95% confidence interval 0.01–0.06). Conclusion: Preoperative progressive pneumoperitoneum and Botulinum Toxin A can facilitate fascial closure without causing significant numbers of adverse events. Botulinum Toxin A qualifies for low-threshold use, yet progressive pneumoperitoneum should be used cautiously owing to a larger number of complications. Definitive recommendations cannot be made as the quality of included studies is low, bias is present, and comparative information is scarce. Registration number Information about the design and conduct of this systematic review has been registered on PROSPERO, registration number CRD42020181679.
UR - http://www.scopus.com/inward/record.url?scp=85104582635&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2021.03.027
DO - 10.1016/j.surg.2021.03.027
M3 - Article
C2 - 33888320
AN - SCOPUS:85104582635
SN - 0039-6060
VL - 170
SP - 769
EP - 776
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -