{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T16:56:40Z","timestamp":1773421000780,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Purpose: Giant inguinal hernias (GIHs) are rare and technically demanding conditions, associated with loss of domain and abdominal wall compliance. Preoperative botulinum toxin type A (BtxA) has been increasingly used in complex ventral hernia repair to facilitate abdominal wall relaxation; however, its role in GIHs surgery remains poorly defined. This scoping review aimed to map the literature on preoperative BtxA use in GIHs repair, focusing on technical protocols, patient selection, and areas of variability. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. MEDLINE, Embase, Web of Science, and Scopus were searched from inception to 10 October 2025. Studies reporting preoperative BtxA administration in adult patients undergoing GIHs repair were included. Data were extracted descriptively and synthesized narratively. Results: Seven observational and non-comparative studies published between 2019\u20132025 were included, comprising a total of 16 patients. Substantial heterogeneity was observed in BtxA protocols, with total doses ranging from 100 to 450 units, injection timing between 2 and 8 weeks preoperatively, and injection sites varying from 6 to 18. In several reports, BtxA was used as part of a multimodal preoperative strategy including progressive pneumoperitoneum. All studies targeted the lateral abdominal wall musculature, employed imaging guidance, and performed bilateral injections. Patient selection criteria and outcome reporting were inconsistent. Conclusions: Preoperative BtxA use in GIHs repair is limited and heterogeneous. No standardized protocol can be identified. Further anatomically focused and systematically designed studies are required to clarify the role of BtxA and to establish standardized preoperative protocols for this challenging surgical condition.<\/jats:p>","DOI":"10.3390\/medsci14010135","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:06:22Z","timestamp":1773414382000},"page":"135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Botulinum Toxin Type A Use in Giant Inguinal Hernia Repair: A Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3122-5531","authenticated-orcid":false,"given":"Agostino","family":"Fernicola","sequence":"first","affiliation":[{"name":"Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, \u201cFederico II\u201d University of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Ricciardelli","sequence":"additional","affiliation":[{"name":"Unit of Emergency Surgery, Dei Colli Hospital, CTO Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0151-8230","authenticated-orcid":false,"given":"Alessio","family":"Cece","sequence":"additional","affiliation":[{"name":"Department of Integrated Activities in Surgery, Orthopedy and Hepato-Gastroenterology, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Floriana","family":"Porcaro","sequence":"additional","affiliation":[{"name":"Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, \u201cFederico II\u201d University of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1926-5562","authenticated-orcid":false,"given":"Domenico","family":"Parmeggiani","sequence":"additional","affiliation":[{"name":"Department of Integrated Activities in Surgery, Orthopedy and Hepato-Gastroenterology, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Unit of Emergency Surgery, Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5699-150X","authenticated-orcid":false,"given":"Gennaro","family":"Quarto","sequence":"additional","affiliation":[{"name":"Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, \u201cFederico II\u201d University of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Demma, J.A., Gefen, R., Shpigelman, O., Pikarsky, A., and Almogy, G. 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