{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T22:55:55Z","timestamp":1776466555572,"version":"3.51.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["J. Abdom. Wall Surg."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Repairing complex abdominal wall hernias is challenging, often requiring component separation techniques (CST) for tension-free closure. Adjuvant therapies, such as botulinum toxin type A (BTA), preoperative progressive pneumoperitoneum (PPP), and intraoperative fascial traction (IFT), may reduce the need for CST by improving abdominal wall compliance and reduce the complexity of the hernia. There is limited knowledge about the effects of their combined use. Our aim is to evaluate the rate of CST in abdominal wall reconstruction for complex midline hernias after adjuvant therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted on patients who underwent surgery for correction of midline complex abdominal hernias between June 2020 and June 2024. Patients submitted to BTA, PPP, or\/and IFT were included. Exclusion criteria were non-midline hernias, non eletive surgeries and less than 3\u00a0months of follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 44 patients studied, 61.4% underwent abdominal wall reconstruction without requiring CST. Traditional predictors like component separation index and rectus\/defect ratio were not associated with a higher rate of CST after adjuvant therapies. 45.5% of patients underwent a combination of adjuvant techniques (BTA + PPP or BTA + IFT). The early and late complication rates were 20.5% and 9.1%. A recurrence rate of 4.5% was reported after a median follow-up of 13 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that adjuvant therapies may influence the surgical approach to abdominal wall reconstruction. The synchronous application of adjuvant therapies, both preoperatively and intraoperatively, could enhance their effect and contribute to the use of less disruptive techniques.<\/jats:p><\/jats:sec>","DOI":"10.3389\/jaws.2025.14515","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T05:10:07Z","timestamp":1756703407000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Complex Abdominal Wall Hernias: Structured Use of Adjuvant Therapies"],"prefix":"10.3389","volume":"4","author":[{"given":"Joana","family":"Marques\u2010Antunes","sequence":"first","affiliation":[]},{"given":"Egon","family":"Rodrigues","sequence":"additional","affiliation":[]},{"given":"Marta","family":"Guimar\u00e3es","sequence":"additional","affiliation":[]},{"given":"Ana Marta","family":"Pereira","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.jss.2020.03.033","article-title":"Histology and Function of the Rectus Abdominis Muscle in Patients with Incisional Hernia","volume":"253","author":"Jensen","year":"2020","journal-title":"J Surg Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.jamcollsurg.2013.11.014","article-title":"Comparative Radiographic Analysis of Changes in the Abdominal Wall Musculature Morphology After Open Posterior Component Separation or Bridging Laparoscopic Ventral Hernia Repair","volume":"218","author":"De Silva","year":"2014","journal-title":"J Am Coll Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1097\/sla.0000000000001827","article-title":"Abdominal Wall Reconstruction for Incisional Hernia Optimizes Truncal Function and Quality of Life: A Prospective Controlled Study","volume":"265","author":"Jensen","year":"2017","journal-title":"Ann Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/bf01658869","article-title":"The Treatment of Complicated Groin and Incisional Hernias","volume":"13","author":"Stoppa","year":"1989","journal-title":"World J Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.amjsurg.2012.02.008","article-title":"Transversus Abdominis Muscle Release: A Novel Approach to Posterior Component Separation During Complex Abdominal Wall Reconstruction","volume":"204","author":"Novitsky","year":"2012","journal-title":"Am J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"24","DOI":"10.3389\/fsurg.2018.00024","article-title":"What do we Know About Component Separation Techniques for Abdominal Wall Hernia Repair?","volume":"5","author":"Scheuerlein","year":"2018","journal-title":"Front Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/j.amjsurg.2021.01.010","article-title":"Preoperative Botulinum Toxin A Injection in Complex Abdominal Wall reconstruction-a propensity-scored Matched Study","volume":"222","author":"Deerenberg","year":"2021","journal-title":"Am J Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"12650","DOI":"10.3389\/jaws.2024.12650","article-title":"Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review","volume":"3","author":"Giuffrida","year":"2024","journal-title":"J Abdom Wall Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"616669","DOI":"10.3389\/fsurg.2020.616669","article-title":"Intraoperative Fascia Tension as an Alternative to Component Separation. 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