Diagnostic value of shear wave elastography in assessing the effectiveness of preoperative botulinum toxin type A therapy in patients with postoperative ventral hernias W3.

INTRODUCTION: Complex W3 ventral hernias with loss of domain (LOD) pose challenges in abdominal wall reconstruction due to pathological retraction and increased stiffness of the lateral abdominal muscles. Preoperative botulinum toxin type A (BTA) facilitates tension-free closure, but objective assessment remains poorly standardized. Two-dimensional shear wave elastography (2D-SWE) enables non-invasive quantification of tissue stiffness. METHODS: This prospective study included 20 healthy volunteers (control) and 6 patients with EHS W3 ventral hernias. Reference stiffness values for external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were established using 2D-SWE. Patients underwent stiffness measurements before BTA, one month after BTA, and at 1,3,6,12 months postoperatively. All underwent Rives-Stoppa hernioplasty. RESULTS: Control reference values were 13.38 kPa (EO), 13.61 kPa (IO), and 15.23 kPa (TrA). Before BTA, hernia patients showed elevated EO (24.2 ± 4.8) and IO (20.6 ± 2.3) stiffness (p < 0.001), while TrA stiffness (17.8 ± 3.6) did not differ from controls (p = 0.09). One month after BTA, stiffness decreased (EO: 14.3 ± 2.4, p = 0.21 vs. controls; IO: 10.2 ± 1.8, p < 0.001; TrA: 9.6 ± 1.2, p < 0.001). Postoperative stiffness progressively declined through 12 months (EO: 7.8 ± 0.9; IO: 7.4 ± 0.8; TrA: 7.3 ± 0.4). Primary fascial closure was achieved in all patients without additional component separation. CONCLUSIONS: 2D-SWE provides objective assessment of BTA-induced muscular relaxation and postoperative remodeling. Established control reference values enable reliable stratification of pathological stiffness and monitoring of therapeutic response, supporting personalized surgical planning.