Botox thins lateral muscle bundle prior to complex hernia surgery

Botox was administered preoperatively to thin the lateral muscle bundle. Six months after reconstructing the abdominal wall to close the 14-centimeter hernia, the patient was fully recovered.

The patient

This mid-60s gentleman presented with significant pain and decreased mobility while hospitalized for another procedure. He is a former smoker and quit two years prior to our evaluation. We were asked to evaluate him for large midline incisional hernia.


A preoperative CT scan shows a hernia measuring 14 centimeters by 22.5 centimeters with loss of domain. It had significant impact on the patient’s daily activities.

The challenge

The patient had undergone an open appendectomy via midline incision several years prior. A week after the appendectomy, he required reoperation for small bowel obstruction. He later developed a hernia at his midline incision. A CT scan showed a hernia measuring 14 centimeters by 22.5 centimeters with loss of domain.

The physicians

Alexandra C. Maki, M.D.
General surgeon
Norton Surgical Specialists
Bryan Denham, M.D.
Diagnostic radiologist
Norton Healthcare diagnostic testing and medical imaging

The solution


A CT scan shows the hernia width shrinking from 14 centimeters to 12 centimeters after Botox treatment.

Given width and retraction of lateral muscles, Botox was administered to promote thinning of the lateral muscle bundle.

The result


Preoperative CT scan on the left is compared with the image on the right showing the abdominal wall reconstruction six months after surgery.

At a six month follow-up, the abdominal wall reconstruction was performing as expected, and the patient recovered without issue.

Refer a patient

To refer a patient to Norton Surgical Specialists, visit Norton EpicLink and open an order for General Surgery.

Refer online


Call (888) 4-U-NORTON/(888) 486-6786


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