Botulinum Toxin for giant omphalocele abdominal wall reconstruction

Introduction: The use of Botulinum Toxin A (BTA) has been shown to be safe and efficacious in neuromuscular blockade in both adult and pediatric patients. While BTA injections have been used safely in the pediatric population for a variety of medical conditions, its use in pediatric abdominal wall reconstruction has not been described. This report describes a unique surgical technique that will increase abdominal domain and allow for earlier closure of giant omphalocele defects. Case report: A 33-week twin premie was born with a giant omphalocele. In an effort to achieve primary closure without the need for mesh, BTA injections were performed under ultrasound guidance two weeks prior to a planned closure. BTA injections included administration of 8 units at separate sites of the abdominal musculature bilaterally. After reduction, a component separation, and primary approximation of the fascial defect were achieved without signs of abdominal compartment syndrome. Conclusion: BTA injection into the abdominal wall musculature provides a safe and effective mechanism to increase laxity of the abdominal wall musculature and decrease tension on the reconstruction for giant omphaloceles defects. The use of BTA may allow earlier repair in this subset of patients without the need for mesh.