Abstract Committee Review

This abstract addresses an interesting and clinically relevant concept—the use of botulinum toxin to facilitate abdominal hernia repair and reduce postoperative pain. However, the conclusions are overstated relative to the very limited data presented. The report includes only two patients, without any control group or comparative baseline, which precludes any meaningful inference about efficacy, safety, or reproducibility. The authors should clearly acknowledge that this is merely a case observation, not a demonstration of therapeutic benefit.

The interpretation of reduced hernia size and postoperative pain as causal effects of botulinum toxin injection should be significantly tempered. These outcomes could equally reflect natural variability, differences in surgical technique, or patient-specific factors. Phrasing such as “can be beneficial” implies a level of evidence that is not supported by two uncontrolled cases. A more appropriate formulation would emphasize that the approach was feasible and well tolerated in this very small case series and warrants systematic investigation in larger controlled studies.

The methods section requires additional detail. Specifically, the authors should report:

• Which botulinum toxin formulation was used (onabotulinumtoxinA, abobotulinumtoxinA, or incobotulinumtoxinA),
• Exact injection sites and dosing per muscle (currently described inconsistently), and
• The rationale for the total dose and target selection.

Clarifying these parameters is essential for reproducibility and for readers to compare this approach with prior literature.

In summary, while the concept is intriguing, the current data are anecdotal and insufficient to support the stated conclusions. The authors are encouraged to reframe their findings as preliminary and focus on reporting procedural feasibility and safety, rather than implying proven efficacy.