Application of botulinum toxin as part of the multimodal treatment of complex postoperative hernias

Introduction: Anterior abdominal wall hernias are one of the most common surgical diseases, the treatment of which is perceived by patients and many surgeons as routine and easy. This perception can be very misleading in the case of so-called complex hernias, in which standard techniques can lead to serious technical difficulties, a high risk of recurrence, and even a threat to the patient's life if compartment syndrome occurs.Case presentation: We present a 47-year-old obese man with a complex postoperative hernia after two previous unsuccessful interventions with the placement of a Mesh, described below. In 2007, a gastric band was placed for weight loss. In 2011, during hospitalization for gangrenous cholecystitis, intraluminal migration of the device with its entrapment in the ileum was detected, which is why cholecystectomy and device extraction with enterotomy and subsequent intestinal suturing were performed. Due to suture insufficiency, peritonitis, and necrotizing fasciitis, relaparotomy with intestinal resection and multiple revisions of the surgical wound and treatment with VAC© was carried out. In 2013, a hernioplasty complicated by wound infection was conducted, and the patient was treated again with VAC©. In 2018, the patient underwent a new hernioplasty with the placement of a two-component Symbotex© Mesh.Conclusion: Complex anterior abdominal wall hernias are a challenging pathology that often requires a multidisciplinary approach. The most important condition for their successful treatment is a detailed assessment of the hernia and risk factors, followed by precise treatment planning. Botulinum toxin is a safe and useful adjunct in the treatment of complex ventral hernias.