ABSTRACT
BACKGROUND: Although the effects of botulinum toxin A on hernia reconstruction have been consistently reported, few studies provide objective evidence. The authors aimed to compare the effects of chemical component separation with those of mechanical component separation, and with a combination of chemical and mechanical component separation, in a rat hernia model. METHODS: Rats were divided into four groups: 1, control; 2, chemical component separation; 3, mechanical component separation; and 4, chemical and mechanical component separation. Four weeks after hernia induction, botulinum toxin A was injected into groups 2 and 4. Hernia repair was performed 2 weeks after chemical component separation when mechanical component separation was performed in groups 3 and 4. Pretreatment and posttreatment defect sizes, traction forces, intraabdominal pressure, and hernia recurrences were analyzed. RESULTS: The defect size was significantly decreased in groups 2 and 4 after chemical component separation. The traction force was significantly smaller in groups 2 and 3 compared with the control group, and the effects of chemical and mechanical component separation were additive. The mean intraabdominal pressure was 16.83 mmHg in group 1, 10.67 mmHg in group 2, 10.17 mmHg in group 3, and 9.67 mmHg in group 4, thus showing significant reductions following chemical and mechanical component separation. Recurrence was observed in all six animals (100 percent) in groups 1 and 3, but in only one of six (17 percent) in groups 2 and 4. CONCLUSIONS: Preoperative botulinum toxin A significantly reduces hernia size (by 30 percent) and the traction force required to medialize the rectus abdominis. After hernia repair, chemical component separation decreases the intraabdominal pressure to a similar degree as mechanical component separation, but only chemical component separation appears to reduce hernia recurrence.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Herniorrhaphy/methods , Incisional Hernia/drug therapy , Incisional Hernia/surgery , Rectus Abdominis/surgery , Animals , Combined Modality Therapy , Disease Models, Animal , Male , Rats , Rats, Sprague-DawleyABSTRACT
Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.
Subject(s)
Abdominal Pain/surgery , Depression/psychology , Hysterectomy/adverse effects , Unnecessary Procedures/adverse effects , Adult , Couples Therapy , Depression/etiology , Female , Health Knowledge, Attitudes, Practice , Hormone Replacement Therapy , Humans , Hysterectomy/psychology , Incisional Hernia/drug therapy , Incisional Hernia/etiology , IndiaABSTRACT
PURPOSE: Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH). METHODS: Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%. RESULTS: The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500-13.250), over a period of 14.3 ± 1.3 days (13-16). BT administration time was 40.2 ± 3.3 days (37-44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12-60) and we reported 2 cases of hernia recurrence (4.4%). CONCLUSIONS: Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.