Botulinum toxin, progressive pneumoperitoneum and RTL closure for ventral hernias secondary to giant omphalocele in children: a 10-patient series.

INTRODUCTION: This study describes a pediatric strategy to repair complex ventral hernias secondary to giant omphaloceles, avoiding the use of mesh and component separation. The protocol combines prehabilitation with botulinum toxin (BT), selective preoperative progressive pneumoperitoneum (PPP) and midline closure by the reinforced tension line (RTL) technique, with the aim of evaluating its safety, feasibility and medium-term results. METHODS: A retrospective, descriptive and multicenter case series was conducted in 10 patients under 18 years of age with ventral hernia secondary to giant omphalocele. All patients received BT; PPP was indicated in patients whose Tanaka index was ≥25%. Surgical closure was performed using the RTL technique, without prosthetic material. Clinical characteristics, dimensions of the defect, use of prehabilitation, complications, hospital stay, follow-up and recurrence were analyzed. RESULTS: Ten patients were included, all of whom were female, with a median age of 3.7 years and a median weight of 12.7 kg. The median defect area was 60 cm². Four patients required progressive pneumoperitoneum. Primary fascial closure was achieved in 100% of cases, without mesh or separation of components. There were no intraoperative complications. The median hospital stay was 6.5 days, and the median follow-up was 19.8 months. No recurrences were documented. CONCLUSIONS: The combined protocol seems safe and technically viable in this initial series. It allowed primary fascial closure without mesh, without separation of components and without recurrences during follow-up. However, these results should be interpreted as preliminary evidence because of the retrospective design, small sample size and absence of a control group.