AUTHOR=Klein Angelina , Wöhler Aliona , Schwab Robert , Güsgen Christoph , Willms Arnulf , Schaaf Sebastian 
  
TITLE=Patient Experience and Surgical Outcomes of Botulinum Toxin A Treatment in Complex Abdominal Wall Hernias: A Retrospective Analysis
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.15899
  
DOI=10.3389/jaws.2026.15899
  
ISSN=2813-2092
  
ABSTRACT=BackgroundBotulinum toxin A (BTA) is increasingly used for preoperative conditioning in patients with large or complex abdominal wall hernias. Injection into the lateral abdominal muscles 4–6 weeks before surgery induces temporary muscular relaxation and facilitates primary fascial closure, even in extensive defects (EHS W3), potentially reducing the need for component separation. While surgical outcomes are well documented, data on patient-reported experiences during the preoperative period remain limited. This retrospective study evaluated patient-reported symptoms between BTA injection and surgery and analyzed surgical results in this cohort.MethodsBetween 2018 and 2024, 50 patients with complex abdominal wall hernias received preoperative BTA treatment followed by surgical repair. Demographic and surgical data, as well as BTA-related complications, were analyzed descriptively. A retrospective questionnaire assessed subjective experiences from injection to surgery, focusing on pain, physical changes (e.g., abdominal contour, trunk stability), and functional impairments (e.g., breathing, urination, defecation).ResultsThe study included 31 men and 19 women (mean age 63.5 years, BMI 28 kg/m2). The mean transverse defect width was 12.06 cm, with an average area of 170.24 cm2. Thirty eight patients had W3 hernias according to EHS (≥10 cm), while BTA was also used in selected cases with smaller defects with complicating factors. No major BTA-related complications occurred; minor hematomas were observed. The mean interval between injection and surgery was 39 days. Primary fascial closure was achieved in all patients. Mesh reinforcement was used in all cases, most commonly in sublay position (n = 47). A transversus abdominis release was performed in 28 cases (52%), and anterior component separation in five. Twenty-two patients (44%) completed the questionnaire. Injection pain ranged from NRS 1–8, typically resolving within 1–3 days; three patients reported no pain. Eight noticed abdominal contour changes, and two reported altered trunk function. One patient experienced mild shortness of breath and another constipation; no urinary issues occurred.ConclusionPreoperative BTA conditioning is a safe and effective adjunct for abdominal wall reconstruction in complex hernias. The treatment facilitates fascial closure, avoids major complications, and causes only minor, short-lived discomfort or functional limitations, maintaining overall quality of life in the preoperative phase.