An incisional hernia or eventration occurs after an abdominal operation if the suture on the muscular wall slowly weakens and allows abdominal content to pass through (grease and intestine). It is necessary in this case to operate to repair the hernia in order to avoid serious complications. If the eventration is not very wide, the doctor simply closes it again with a new suture while using or not using a mesh. If the eventration is very large, procedures must be used to repair it. One technique consists of placing an intraperitoneal mesh in front of the hole. This is therefore not closed but it prevents the intestine from passing through it. The disadvantage of this procedure is the insertion of a foreign body in direct contact with the intestine. Adhesions may be created increasing the risk of occlusion and difficulties in the case of emergency abdominal surgery.
Eventration may also be treated by means of the section of lateral muscle attachments making it possible to gain the few centimetres required for the closure. The surgeon then reinforces the area using a mesh, not intraperitoneally but placed on the posterior sheath of the muscles and covered by the muscle and anterior sheath. Although this method provides good results it has the disadvantage of weakening and damaging the original abdominal structural balance.
The use of botox in the treatment of incisional hernias represents a less invasive alternative to the section of the lateral muscle attachments. In fact the botulinum toxin makes it possible to gain in muscular relaxation and to close the eventration without resorting to this section. The doctor proceeds under ultrasound with five injections on each side of the abdominal muscles. The maximum effect is obtained three or four weeks afterwards and it is at this time that the surgical intervention takes place. Once the hernia is closed, the surgeon places the mesh as in the previous technique. Furthermore, if the eventration is really enormous, the surgeon may decide to combine the section of the lateral attachments with the botox.
In future, the use of botox could become the effective first-line treatment for large-sized incisional hernias.
Dr Jean-Marie Mégevand, specialist in visceral surgery, general surgery and traumatology