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/m (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.