{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T19:38:30Z","timestamp":1777059510323,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The management of giant inguinoscrotal hernias remains a challenge as a result of the loss of the intra-abdominal domain from long-standing hernia contents within the scrotum. Multiple techniques have been described for abdominal wall relaxation and augmentation to allow the safe return of viscera from the scrotum to the intraperitoneal cavity without adversely affecting cardiorespiratory physiology. Preoperative progressive pneumoperitoneum, phrenectomy, and component separation are but a few common techniques previously described as adjuncts to the management of these massively large hernias. However, these strategies require an additional invasive stage, and reproducibility remains challenging. Botulinum toxin A (BTA) has been successfully used for the management of complex ventral hernias. Its use for these hernias has shown reproducibility and a low side effect profile. In the present report, we describe our institutional experience with BTA for giant inguinal hernias in two patients and present a review of the literature. In one case, a 77-year-old man with a substantial cardiac history presented with a giant left inguinal hernia that was interfering with his activities of daily living. He had BTA six weeks prior to inguinal hernia repair. Repair was performed via an inguinal incision with a favorable return of the viscera into the peritoneum. He was discharged on the same day of the operation. A second patient, 78 years of age, had a giant right inguinoscrotal hernia. He had a significant cardiac history and was treated with BTA six weeks prior to inguinal hernia repair via a groin incision. Neither patient had complaints nor recurrence at 7- and 3-month follow-ups. While the literature on this topic is scarce, we found 13 cases of inguinal hernias treated with BTA as an adjunct. BTA might be a promising adjunct for the management of giant inguinoscrotal hernias in addition to or in place of current strategies.<\/jats:p>","DOI":"10.3390\/jcm13071879","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T12:32:36Z","timestamp":1711369956000},"page":"1879","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Botulinum Toxin A as an Adjunct for the Repair Giant Inguinal Hernias: Case Reports and a Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7720-419X","authenticated-orcid":false,"given":"Sergio","family":"Huerta","sequence":"first","affiliation":[{"name":"Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4207-066X","authenticated-orcid":false,"given":"Roma","family":"Raj","sequence":"additional","affiliation":[{"name":"Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Management, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMcp1404068","article-title":"Clinical practice. Groin hernias in adults","volume":"372","author":"Fitzgibbons","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1001\/jama.295.3.285","article-title":"Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: A randomized clinical trial","volume":"295","author":"Fitzgibbons","year":"2006","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.amjsurg.2016.01.036","article-title":"Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients","volume":"212","author":"Huerta","year":"2016","journal-title":"Am. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jss.2019.03.046","article-title":"Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications","volume":"241","author":"Huerta","year":"2019","journal-title":"J. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0039-6109(16)43287-1","article-title":"Scrotal reconstruction for giant inguinal hernias","volume":"64","author":"Hodgkinson","year":"1984","journal-title":"Surg. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1007\/s00595-009-4125-3","article-title":"Challenging surgical management of a giant inguinoscrotal hernia: Report of a case","volume":"40","author":"Vasiliadis","year":"2010","journal-title":"Surg. Today"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"560","DOI":"10.9738\/INTSURG-D-13-00083.1","article-title":"Giant inguinoscrotal hernia--report of a rare case with literature review","volume":"99","author":"Karthikeyan","year":"2014","journal-title":"Int. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.jamcollsurg.2005.04.037","article-title":"Incarcerated vesicoinguinal hernia presenting with gross hematuria","volume":"201","author":"Huerta","year":"2005","journal-title":"J. Am. Coll. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1054\/bjps.2000.3383","article-title":"Repair of a giant inguinoscrotal hernia","volume":"53","author":"Mehendal","year":"2000","journal-title":"Br. J. Plast. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/j.1445-2197.1994.tb02231.x","article-title":"Repair of giant inguinoscrotal inguinal hernia using marlex mesh and scrotal skin flaps","volume":"64","author":"Merrett","year":"1994","journal-title":"Aust. N. Z. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Favela, J.G., Argo, M.B., McAllister, J., Waldrop, C.L., and Huerta, S. (2023). Gastric Outlet Obstruction from Stomach-Containing Groin Hernias: Case Report and a Systematic Review. J. Clin. Med., 13.","DOI":"10.20944\/preprints202311.1665.v1"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10029-001-0030-4","article-title":"Preperitoneal mesh hernioplasty in giant inguinoscrotal hernias: A new technique with dual benefit in repair and abdominal rooming","volume":"5","year":"2001","journal-title":"Hernia"},{"key":"ref_13","first-page":"71","article-title":"Botulinum toxin A as an adjunct to giant inguinal hernia reparation","volume":"88","year":"2020","journal-title":"Cir. Cir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0039-6109(16)45981-5","article-title":"Complications of laparoscopic surgery","volume":"73","author":"Crist","year":"1993","journal-title":"Surg. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"753889","DOI":"10.3389\/fsurg.2021.753889","article-title":"The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure","volume":"8","author":"Windsor","year":"2021","journal-title":"Front. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s10029-016-1478-6","article-title":"Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A","volume":"20","author":"Elstner","year":"2016","journal-title":"Hernia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1007\/s00268-009-0203-3","article-title":"Use of botulinum toxin type a before abdominal wall hernia reconstruction","volume":"33","year":"2009","journal-title":"World J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/ans.13258","article-title":"Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair","volume":"86","author":"Farooque","year":"2016","journal-title":"ANZ J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00256-020-03533-6","article-title":"Image-guided botulinum toxin injection in the lateral abdominal wall prior to abdominal wall reconstruction surgery: Review of techniques and results","volume":"50","author":"Deerenberg","year":"2021","journal-title":"Skelet. Radiol."},{"key":"ref_20","first-page":"269","article-title":"Complications of groin hernia","volume":"Volume 4","author":"Nyhus","year":"1995","journal-title":"Hernia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s10029-008-0346-4","article-title":"Single-stage repair of giant inguinoscrotal hernias using the abdominal wall component separation technique","volume":"12","author":"Valliattu","year":"2008","journal-title":"Hernia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1111\/j.1445-2197.2006.03894.x","article-title":"Component separation in the repair of a giant inguinoscrotal hernia","volume":"76","author":"Ek","year":"2006","journal-title":"ANZ J. Surg."},{"key":"ref_23","first-page":"132","article-title":"Progressive pneumoperitoneum in treatment of inguinal and scar hernias. Results of animal experiments and clinical applications","volume":"381","author":"Willis","year":"1996","journal-title":"Langenbecks Arch. Chir."},{"key":"ref_24","first-page":"945","article-title":"Chronic eventrations and large hernias; preoperative treatment by progressive pneumoperitomeum; original procedure","volume":"22","author":"Moreno","year":"1947","journal-title":"Surgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"rjt008","DOI":"10.1093\/jscr\/rjt008","article-title":"Repair of massive inguinal hernia with loss of abdominal domain using laparoscopic component separation technique","volume":"2013","author":"Hamad","year":"2013","journal-title":"J. Surg. Case Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/00006534-199708000-00007","article-title":"Massive abdominal-wall hernia reconstruction with expanded external\/internal oblique and transversalis musculofascia","volume":"100","author":"Jacobsen","year":"1997","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s10029-009-0533-y","article-title":"Repair of a giant inguinoscrotal hernia","volume":"14","author":"Patsas","year":"2010","journal-title":"Hernia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1089\/lap.2019.0669","article-title":"Combination of Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A Enables the Laparoscopic Transabdominal Preperitoneal Approach for Repairing Giant Inguinoscrotal Hernias","volume":"30","author":"Tang","year":"2020","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"rjaa012","DOI":"10.1093\/jscr\/rjaa012","article-title":"Bilateral giant inguinoscrotal hernia. Presentation of a novel combined two-stage repair approach","volume":"2020","author":"Menenakos","year":"2020","journal-title":"J. Surg. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1111\/ans.14806","article-title":"Combination of botulinum toxin A, progressive pre-operative pneumoperitoneum for the repair of loss domain inguinal hernias","volume":"89","author":"Gonzalo","year":"2019","journal-title":"ANZ J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"164","DOI":"10.20960\/rhh.106","article-title":"Combinaci\u00f3n de toxina botul\u00ednica A y neumoperitoneo preoperatorio progresivo abreviado como t\u00e9cnica adyuvante para la reparaci\u00f3n de grandes hernias de la regi\u00f3n inguinal. Reporte de un caso","volume":"5","author":"Palmisano","year":"2017","journal-title":"Rev. Hisp. Hernia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/bjs\/znaa050","article-title":"Understanding the benefits of botulinum toxin A: Retrospective analysis of the Abdominal Core Health Quality Collaborative","volume":"108","author":"Horne","year":"2021","journal-title":"Br. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.surg.2021.03.027","article-title":"Fascial closure in giant ventral hernias after preoperative botulinum toxin a and progressive pneumoperitoneum: A systematic review and meta-analysis","volume":"170","author":"Yurtkap","year":"2021","journal-title":"Surgery"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s10029-019-01939-3","article-title":"Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair","volume":"24","author":"Elstner","year":"2020","journal-title":"Hernia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/1879\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:17:59Z","timestamp":1760105879000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/1879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,25]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13071879"],"URL":"https:\/\/doi.org\/10.3390\/jcm13071879","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,25]]}}}