Complex ventral hernia repair in a child : an association of botulinumtoxin, progressive pneumoperitoneum and negative pressure therapy : a case report on an arising surgical technique

INTRODUCTION: The purpose of this manuscript is to report the management of a child born with giantomphalocele (GO) that developed a complex ventral hernia secondary to an unsuccessful attempt ofclosing the primary defect. PRESENTATION OF CASE: The patient underwent a one-step surgery to correct a ventral hernia associatedwith a largely prolapsed enteroatmospheric fistula (EAF) along with an ileostomy. It was managed bya pre-operative association of botulinum toxin agent (BTA) application with preoperative progressivepneumoperitoneum (PPP) and trans-operative negative pressure wound therapy (NPWT) dressing withstaged abdominal closure. The patient needed 4 reoperations due to enteric fistulas. Nine days after thefirst surgery, it was possible to completely close the abdominal wall without mesh substitution. No signsof hernia in 9 months of follow-up. DISCUSSION: This is the second report in the literature and it reinforces the safety and effectiveness ofthe BTA injection associated with PPP in children. CONCLUSION: The use of BTA in association with PPP should be encouraged and best investigated inpatients with GO. The fistulas were not attributed to the negative pressure. Maybe it is time to startdefining better criteria to categorize GO in order to choose the best management for each patient.