Adjuvant botulinum toxin for endoscopic management (preaponeurotic endoscopic repair) of severe diastasis recti
Derlin Marcio Juarez Muas1, Ezequiel Mariano Palmisano2, Guillermo Pou Santoja3, Olga Rosa Mustone Paz4
1 Member of the Argentine Association of Surgery, Member of the Argentine Association of Hernias, Member of the Hispano-American Society of Hernias, Member of the Salta Surgery Society, Staff Surgeon of the General Surgery Service, Maternal and Child Public Hospital, Salta, Argentine Republic
2 Hospital Español of Rosario, Santa Fe (Argentine Republic), Italian University Institute of Rosario, IUNIR, Salta, Argentine Republic
3 Member of the Spanish Association of Surgery, Member of the Hispano-American Society of Hernias, Head of the General Surgery Service, Abdominal Wall Sector, Vithas NISA 9 de Octubre Hospital, Valencia, Spain
4 Member of the Venezuelan Society of Surgery, Associate of the General Hospital of Almansa, Associate of the Specialized Abdominal Wall Consultation at the Vithas NISA 9 de Octubre Hospital, Valencia, Spain
Dr. Derlin Marcio Juarez Muas
Maternal-Infant Public Hospital - Salta, Av. Sarmiento, 1301, Salta (Argentine Republic), Passage 1, Nº. 16. La Almudena Neighborhood, 4400, Salta
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Diastasis recti (DR) associated with midline hernias is common. Big size DR represents a clinical and cosmetic problem. Its repair is challenging, with intraoperative and postoperative risks. The adjuvant of botulinum toxin serotype A makes it possible to restoration of the linea alba by preaponeurotic endoscopic repair (REPA).
METHODS: This was a retrospective study with prospective database. Between February 2019 and July 2020, six women were operated, with a mean age of 39 years and a diagnosis of DR >80 mm, with a body mass index of 27. All patients were infiltrated with 50 UR of botulinum toxin serotype A on each side, 30 days before the surgery.
RESULTS: The intraoperative diagnosis of DR was 87.5 mm average, associated with midline hernias in 100%, with a mean transverse diameter of 24 mm (10–60 mm) Anatomical restoration of the linea alba was performed with a slow absorbable barbed suture. The wall was reinforced with 100% macroporous polypropylene mesh, with 83.3% atraumatic fixation and 16.6% absorbable traumatic fixation. The surgical time was 94 ± 15 min. Postoperative pain was 2/10 ± 1 according to the Visual Analog Scale, allowing a hospital stay of 18 ± 4 h. Return to work 18 ± 3 days. The mean follow-up was 9 (2–18) months by the clinical and ultrasound examination in 100%, without complications or recurrences.
CONCLUSIONS: The application of botulinum toxin serotype A associated with endoscopic repair (REPA) allowed solving the big size DR and midline hernias with suture of the rectus sheath with less tension, associated with a reinforcement prosthesis, allowing a reduced hospitalization with a low level of postoperative pain, avoiding muscle release incisions, which are irreversible and not exempt from morbidity, added to the proven benefits of endoscopic access.