Botulinum Toxin Type A-assisted Mesh-Free Endoscopic Repair of a Pediatric Ventral Hernia After Giant Omphalocele: A Case Report

Residual ventral hernia after giant omphalocele presents a complex reconstructive challenge in pediatric surgery because of altered abdominal wall anatomy, muscular retraction, and the need to achieve closure without excessive tension. Botulinum toxin type A has been used as an adjunct to abdominal wall reconstruction by inducing temporary muscular relaxation, but pediatric experience remains limited, particularly in combination with endoscopic preaponeurotic repair (REPA). We report the case of a five-year-old boy weighing 13.4 kg with a residual ventral hernia after a giant omphalocele. Preoperative ultrasonography demonstrated a 6 cm fascial defect. The patient underwent ultrasound-guided botulinum toxin type A infiltration using 14 injection sites distributed bilaterally along the rectus abdominis and lateral abdominal wall musculature. A total dose of 70 IU was administered. Four weeks later, the defect diameter had decreased to 4 cm, and mesh-free REPA was performed. Complete musculoaponeurotic closure was achieved without prosthetic mesh, progressive preoperative pneumoperitoneum, or surgical component separation. The postoperative course was uneventful, and no clinical recurrence or wound-related complication was observed at 12 months of follow-up. This case describes a technically successful combination of preoperative botulinum toxin type A infiltration and mesh-free REPA in a child with a post-omphalocele ventral hernia.