Patient-Reported Outcomes After Preoperative Botulinum Toxin A Injection Prior to Abdominal Wall Hernia Surgery: An International Survey

Introduction: Botulinum Toxin A is increasingly used as a preoperative adjunct in the management of complex abdominal wall hernias, particularly in those with wider defects and/or loss of domain. While its anatomical and surgical benefits have been documented, patient-reported outcomes remain underexplored. Methods: An international, retrospective, observational study was conducted using a structured, anonymised survey available in five languages (German, English, Polish, French, Spanish). The survey included nine closed-ended and one open-ended question assessing pain perception, mobility, respiratory, gastrointestinal, and urinary function, and changes in abdominal contour. It was distributed by medical teams and through patient support forums between 2024 and 2025. Patients included had received BTA injections 4-6 weeks prior to elective hernia surgery. Results: Seventy patients from multiple European centres completed the survey. Pain during injection was minimal in 71.5% of cases, with 85.7% reporting complete resolution of pain within 1-3 days. Most respondents (74.3%) experienced no breathing difficulties and only mild symptoms in 18.6%. Mobility remained unchanged in 80%, while 15.7% noted slight deterioration. Changes in urinary and bowel function were uncommon and mostly transient. Over half of patients reported visible changes in abdominal shape. No severe complications were identified. Conclusion: This international patient survey suggests that BTA injections as preoperative preparation for complex hernias is well tolerated, with limited perceived side effects and functional disruption. These findings support its continued use and prompts further prospective data collection.