Introduction: Abdominal wall hernias, including incisional hernias, are a common problem with a significant socioeconomic impact in general and pediatric surgery. In the pediatric population, the repair of large or recurrent ventral defects is challenging, with limitations on the use of synthetic meshes due to growth and the risk of complications. Botulinum toxin type A (BTX-A), an exotoxin that paralyzes muscles, has been proposed to facilitate surgical closure by reducing muscle tension, although there are few reports of its use in children. Materials and Methods: This prospective, descriptive, longitudinal study included 5 pediatric patients with severe post-incisional hernias. Botulinum toxin type A (BTX-A) was infiltrated into the abdominal muscles (10 IU per muscle, total 60 IU) 15 days before surgery. Intravesical pressure was measured before and after application to evaluate the reduction in intra-abdominal pressure. Patients were followed for 14 years. Results: Five patients between 6 and 48 months of age were treated. An average reduction of 47.6% in intravesical pressure was observed at surgical closure. Closure was achieved in all patients without complications, with oral feeding initiated between 24 and 48 hours postoperatively and a mean hospital stay of 2.4 days. In long-term follow-up, none of the patients experienced recurrence or complications. Conclusions: TBA is useful and safe for reducing intra-abdominal pressure, facilitating tension-free closure of large ventral hernias in pediatric patients without recurrence during a 14-year long-term follow-up, representing a promising alternative to traditional synthetic materials. Further studies are recommended to validate these results.
Ortiz et al. (Sun,) studied this question.