Complex ventral hernia secondary to giant omphalocele managed by preoperative pneumoperitoneum and botulinum toxin: A case report

Post-omphalocele ventral hernias pose significant challenges in pediatric surgery, often requiring multiple revision surgeries and carrying a high morbidity rate. In this case report, we present the management of a pediatric patient with a complex ventral hernia and loss of domain resulting from a giant omphalocele. A 5-year-old female with a history of omphalocele managed with surgical skin closure at birth presented with a giant ventral hernia. The patient underwent a staged surgical correction that involved muscle paralysis using botulinum toxin (BT) injections, followed by progressive preoperative pneumoperitoneum (PPPP) as a pre-habilitation technique for abdominal wall closure, without the use of prosthetic materials or component separation. Our case demonstrates a successful alternative treatment approach, highlighting the reproducibility, effectiveness, and safety of using BT followed by PPPP in managing post-omphalocele ventral hernias in pediatric patients.