[Giant loss of domain hernia: Preoperative treatment with botulinum toxin of the abdominal oblique muscles]. / Hernia abdominal con pérdida del domicilio: tratamiento preoperatorio con toxina botulínica de la musculatura oblicua abdominal.

In giant loss of domain hernia there is a high risk of abdominal compartment syndrome and restrictive lung disease after complete surgical repair of the fascial defect. We report the case of a 54-year-old man with a late-stage right giant mesogastric loss of domain hernia who began preoperative treatment with progressive pneumoperitoneum. After evaluation of the muscles and skin, ultrasound and electromyographic-guided infiltration of botulinum toxin type A was performed in the abdominal oblique muscles. It caused a flaccid paralysis of the wall and allowed advancement of the lateral flaps without weakening them. The patient underwent surgery one month later with complete closure of the defect and with no signs of respiratory failure or compartment syndrome. The use of botulinum toxin in the preoperative treatment of patients with loss of domain hernias seems a safe and effective therapeutic option.

Hernia abdominal con pérdida del domicilio: tratamiento preoperatorio con toxina botulínica de la musculatura oblicua abdominal / Giant loss of domain hernia: Preoperative treatment with botulinum toxin of the abdominal oblique muscles

En las hernias gigantes con pérdida del domicilio existe un alto riesgo de síndrome compartimental abdominal y de enfermedad respiratoria restrictiva tras la reparación quirúrgica completa del defecto fascial. Presentamos el caso de un paciente de 54 años con una eventración gigante mesogástrica con pérdida del derecho al domicilio de años de evolución, que ha iniciado tratamiento preoperatorio con neumoperitoneo progresivo. Tras valoración de la pared abdominal y del estado dérmico, se realiza infiltración bajo guía ecográfica y electromiográfica de musculatura oblicua de toxina botulínica tipo A. Provoca una parálisis flácida de la pared y permite el avance de los colgajos laterales sin debilitarlos. Posteriormente se interviene sin presentar signos de insuficiencia respiratoria y con un cierre completo del defecto sin signos de síndrome compartimental. El uso de toxina botulínica en el tratamiento preoperatorio de las hernias gigantes con pérdida del domicilio parece una alternativa terapéutica efectiva y segura

In giant loss of domain hernia there is a high risk of abdominal compartment syndrome and restrictive lung disease after complete surgical repair of the fascial defect. We report the case of a 54-year-old man with a late-stage right giant mesogastric loss of domain hernia who began preoperative treatment with progressive pneumoperitoneum. After evaluation of the muscles and skin, ultrasound and electromyographic-guided infiltration of botulinum toxin type A was performed in the abdominal oblique muscles. It caused a flaccid paralysis of the wall and allowed advancement of the lateral flaps without weakening them. The patient underwent surgery one month later with complete closure of the defect and with no signs of respiratory failure or compartment syndrome. The use of botulinum toxin in the preoperative treatment of patients with loss of domain hernias seems a safe and effective therapeutic option