Use of botulinum toxin type A in giant ventral postoperative hernia

Abstract

Postoperative ventral hernia represents one of the causes of anterior abdominal wall hernias. Repair of this hernia can be very challenging for surgeons, as they are associated with cardiovascular and respiratory complications, development of compartment syndrome, and high recurrence rates. Our case is a 48-year-old woman was operated on twice. The first time was in 2015 due to perforation of colonic diverticulitis for which abdominal exploration and Hartmann’s procedure was performed. In 2016, the reverse of Hartmann’s procedure was done. Forty days after the second operation, she noticed a small hernia in the scar area that increased rapidly. After 1 year, it became irreducible with dimensions (30X17 cm) reached the para-umbilical region without any sign of intestinal obstruction. We decided to do hernioplasty using self-gripping mesh. Six weeks before surgery, botulinum toxin type A was injected intramuscularly to induce muscle weakness and restore the normal biomechanics of the anterior abdominal wall, facilitating closure and repair. Postoperative results and follow-up after 6 months were satisfactory.