Impact of Transversus Abdominis Release (TAR) with Botulinum Toxin (BTX) Injection versus TAR without BTX Injection on Quality of Life and Postoperative Pain in Large Ventral Hernia Repair: A Comparative Study

Background: Large ventral hernias pose significant challenges due to high recurrence rates and financial burdens. Transversus abdominis release (TAR) improves surgical outcomes by reducing abdominal wall tension. Objectives: This study aimed to compare the outcomes of TAR with BTX injection versus without BTX injection in terms of their impact on quality of life and postoperative pain. Methods: We conducted a prospective cohort study of 97 patients undergoing TAR for large ventral hernia repair at Mansoura University Hospital (April 2019–June 2023). Patients were divided into TAR+BTX (n = 55) and TAR-only (n = 42) groups. Outcomes assessed over 12 months included quality of life (HerQLes), intra-abdominal pressure (IAP), postoperative pain (VAS) and recurrence rates. Statistical analysis identified predictors and threshold values for optimizing surgical results. Results: The TAR+BTX group had significantly higher Sabbagh’s indices (13.9% vs. 12.3%, P=0.004) and larger defects (14 cm vs. 12 cm, P<0.001). They also showed greater HerQLes score improvement (107% vs. 91.5%, P=0.006), lower postoperative IAP (5 mmHg vs. 6 mmHg, P<0.001), earlier mobilization (5 vs. 6 hours, P=0.002), and reduced patient-controlled analgesia (PCA) use (23.6% vs. 64.3%, P<0.001). Multivariate analysis identified defect width, preoperative HerQLes scores, and postoperative IAP as key predictors of quality-of-life outcomes. The cutoff analysis determined that defect widths of 13 cm, when used as a standalone criterion, was the optimal threshold for considering BTX injection, with Sabbagh's index playing a less significant role. Conclusion: BTX is a valuable adjunct to TAR resulted in improving quality of life, comparatively lowering IAP, and accelerating recovery in large ventral hernia repairs.