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Preoperative Ultrasound-Guided Botulinum Toxin A Injection Facilitates Closure of a Complex Abdominal Wall Hernia: A Case Report

Tamboli, Mallika BA*,†; Kitamura, Riley MD; Ma, Wendy MD*; Kumar, Gunjan MD*,†; Harrison, T. Kyle MD*,†; Wang, Rachel R. MD*,†; Mariano, Edward R. MD, MAS*,†; Leng, Jody C. MD, MS*,†

doi: 10.1213/XAA.0000000000001033
Case Reports
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Complex abdominal wall hernia repairs can have high failure rates. Many surgical techniques have been proposed with variable success. We report our experience with a new collaborative protocol between general surgery and regional anesthesiology and acute pain medicine services to provide preoperative botulinum toxin A injections to a patient with a large complex ventral hernia to facilitate primary closure. Toxin was administered into the 3 abdominal wall muscle layers under ultrasound guidance at multiple sites 2 weeks before surgery. The resulting flaccid paralysis of the abdominal musculature facilitated a successful primary surgical closure with no postoperative complications.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California

Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California

Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.

Accepted for publication March 29, 2019.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Edward R. Mariano, MD, MAS, Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (112A), Palo Alto, CA 94304. Address e-mail to emariano@stanford.edu.

Copyright © 2019 International Anesthesia Research Society
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