{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:30:36Z","timestamp":1786696236846,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Abdominal hernias with large fascial defects are very difficult to repair, and it is almost impossible to achieve midline closure without causing abdominal compartment syndrome or intra\u2010abdominal hypertension. Preoperative botulinum toxin A (BTA) infiltration into the lateral abdominal wall muscles has been shown to facilitate fascial closure in such cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective interventional study was conducted from October 2023 to April 2025 in adult patients aged \u2265\u200918\u2009years with large midline abdominal wall hernias with a defect width of more than 10\u2009cm. Preoperative computed tomography (CT) was used to measure transverse defect width, lateral abdominal wall muscle length, and Tanaka index. A total dose of 300\u2009IU of BTA (Botox) was administered under ultrasound\u2010guided (USG) guidance into the external oblique, internal oblique, and transversus abdominis muscles bilaterally according to the Ibarra\u2010Hurtado technique. A repeat CT along with volumetry was performed 4\u2009weeks after BTA administration. Surgical repair was done by posterior component separation with transversus abdominis release, and in some cases a peritoneal flap was utilized to achieve midline closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010four patients (8 males and 16 females) with a mean age of 54.1\u2009\u00b1\u200910.8\u2009years were included. A significant reduction in the transverse hernia defect was observed from 17.8\u2009\u00b1\u20094.8\u2009cm to 12.2\u2009\u00b1\u20093.9\u2009cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Significant elongation of lateral abdominal wall muscles on both sides and reduction in the Tanaka index were also observed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A defect width of more than 18\u2009cm with a mean defect of 21.7\u2009\u00b1\u20093.2\u2009cm required an additional peritoneal flap to achieve midline closure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In abdominal wall reconstruction, preoperative BTA is safe and effective in facilitating large midline abdominal wall hernia repair. Very large defects may require additional peritoneal flaps despite BTA administration and component separation techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70902","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:09:32Z","timestamp":1786694972000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Preoperative Botulinum Toxin on the Outcome of Large Midline Hernia Repair"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3752-6586","authenticated-orcid":false,"given":"Ashesh Kumar","family":"Jha","sequence":"first","affiliation":[{"name":"Department of General Surgery and Radiodiagnosis AIIMS  Patna India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Radiodiagnosis AIIMS  Patna India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev Nayan","family":"Priyadarshi","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Radiodiagnosis AIIMS  Patna India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Radiodiagnosis AIIMS  Patna India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh","family":"Nirala","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Radiodiagnosis AIIMS  Patna India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010199809000\u201000033"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2015.124"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.08.015"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010014\u20102722\u20109"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010013\u20102211\u20106"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010009\u20100203\u20103"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s10029-014-1280-2","article-title":"Effect of Botulinum Toxin Type A in Lateral Abdominal Wall Muscles Thickness and Length of Patients With Midline Incisional Hernia Secondary to Open Abdomen Management","volume":"18","author":"Ibarra\u2010Hurtado T. 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