Preoperative botulinum toxin a enables fascial closure and reduces morbidity in complex incisional hernias…

ObservationalHernia : the journal of hernias and abdominal wall surgery· Aug 2026

Preoperative botulinum toxin a enables fascial closure and reduces morbidity in complex incisional hernias: results from the BRIDGE-HERNIA study.

Francesco Pizza, Francesco Saverio Lucido, Alejandro Bravo Salva … Claudio Gambardella

Hernia & Abdominal WallObservationalTreatmentQ1IF 2.3

Preoperative botulinum toxin A was linked to avoiding transversus abdominis release

Preoperative botulinum toxin a enables fascial closure and reduces morbidity in complex incisional hernias: results from the BRIDGE-HERNIA study.

Francesco Pizza … Claudio Gambardella

Hernia · Aug 2026 · Q1 in Surgery

Background

Achieving tension-free midline fascial closure in complex midline incisional hernias frequently necessitates posterior component separation with transversus abdominis release (transversus abdominis release).

Purpose

This study evaluates the impact of BTA within the BRIDGE-HERNIA protocol on surgical management of patients with complex incisional hernia.

Methods

This retrospective multicenter observational cohort study conducted across three centers included 42 patients with complex midline incisional hernias and transverse defect width ≥ 10 cm.

n = 42 patients

Results

chemical relaxation avoided a second, more invasive muscle-release step in most patients

Rives-Stoppa

15.2%

TAR

55.6%

More results

Mean lateral muscle elongation was 3.5 ± 1.2 cm per side, associated with a significant reduction in transverse defect width from 12.4 ± 3.1 cm to 10.1 ± 2.6 cm (p < 0.001).

Fascial closure was achieved in all patients treated with Rives-Stoppa repair.

More results

One early recurrence was observed, occurring in the transversus abdominis release group.

EuraHS-QoL scores demonstrated significant improvement at both 6 and 12 months postoperatively, indicating a sustained enhancement in hernia-specific quality of life.

“

Conclusion · 1 of 2

Preoperative BTA administration within the BRIDGE-HERNIA protocol effectively facilitated midline fascial closure and substantially reduces the need for transversus abdominis release in patients with complex midline incisional hernias.

Conclusion · 2 of 2

This approach appeared safe, was associated with reduced postoperative morbidity and shorter hospitalization, and led to meaningful improvements in patient-reported quality of life.

Preoperative botulinum toxin a enables fascial closure and reduces morbidity in complex incisional hernias: results from the BRIDGE-HERNIA study.

Preoperative botulinum toxin a enables fascial closure and reduces morbidity in complex incisional hernias: results from the BRIDGE-HERNIA study.

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