Complex ventral hernia repair in a child: An association of botulinum toxin, progressive pneumoperitoneum and negative pressure therapy. A case report on an arising surgical technique
- Resource Type
- Authors
- Leandro Totti Cavazzola; José Carlos Soares de Fraga; Carlos Alberto Hoff Peterson; Marcelo Costamilan Rombaldi; Paola M.B. Santis-Isolan; Caroline G. Barreto
- Source
- International Journal of Surgery Case Reports
- Subject
- medicine.medical_specialty
Complex hernia
medicine.medical_treatment
Fistula
Case Report
Giant omphalocele
PICU, Pediatric Intensive Care Unit
Abdominal wall
NPWT, negative pressure wound therapy
PR, primary early repair
03 medical and health sciences
Ileostomy
0302 clinical medicine
BTA, botulinum toxin agent
PN, parenteral nutrition
Pneumoperitoneum
Enteric fistula
Botulinum toxin
Negative-pressure wound therapy
medicine
Hernia
Omphalocele
business.industry
PPP, preoperative progressive pneumoperitoneum
SR, staged early repair
DNR, delayed non-operative repair
Negative pressure wound therapy
medicine.disease
GO, giant omphalocele
Surgery
pod, pos-operative day
medicine.anatomical_structure
EAF, enteroatmospheric fistula
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
business
medicine.drug
- Language
- English
- ISSN
- 2210-2612
Highlights • Giant omphalocele establish a therapeutic challenge to the surgeon - mainly because of the increased visceroabdominal disproportion and underlying malformations - and the best approach is still debatable worldwide. • This is the second report on the literature and states the management of a child born with giant omphalocele that developed a very complex ventral hernia secondary to an unsuccessful attempt of closing the primary defect. • It seems that the use of botulinum toxin agents in the abdominal wall is safe and effective in children with giant omphaloceles and it eliminates the use of a mesh even in more difficult cases. • This technique seems safe and effective and it should be encouraged and best evaluated. • It is time to start defining better criteria to categorize giant omphalocele in order to choose the best management for each patient.
Introduction The purpose of this manuscript is to report the management of a child born with giant omphalocele (GO) that developed a complex ventral hernia secondary to an unsuccessful attempt of closing the primary defect. Presentation of case The patient underwent a one-step surgery to correct a ventral hernia associated with a largely prolapsed enteroatmospheric fistula (EAF) along with an ileostomy. It was managed by a pre-operative association of botulinum toxin agent (BTA) application with preoperative progressive pneumoperitoneum (PPP) and trans-operative negative pressure wound therapy (NPWT) dressing with staged abdominal closure. The patient needed 4 reoperations due to enteric fistulas. Nine days after the first surgery, it was possible to completely close the abdominal wall without mesh substitution. No signs of hernia in 9 months of follow-up. Discussion This is the second report in the literature and it reinforces the safety and effectiveness of the BTA injection associated with PPP in children. Conclusion The use of BTA in association with PPP should be encouraged and best investigated in patients with GO. The fistulas were not attributed to the negative pressure. Maybe it is time to start defining better criteria to categorize GO in order to choose the best management for each patient.