P103 IS BOTULINUM TOXIN PRE-CONDITIONING & 3D PLANNING USEFUL IN A BILATERAL SUBCOSTAL EVENTRATION WITH LAPAROSTOME AND COLOSTOMY?

Aim To assess the usefulness of 3D Planning and preconditioning with botulinum toxin in a complex abdominal wall hernia. Material and Methods A 54-year-old man with sever alcoholic pancreatitis required surgery due to poor evolution, performing subtotal colectomy with a right colon colostomy and necrosectomy by bilateral subcostal laparotomy. After several operations and not being able to close the wall, the use of negative pressure therapy and subsequently skin grafting was required. Abdominal wall 3D Planning was performed and botulinum toxin injection was administered before definite surgery. During surgery, after digestive reconstruction, it was observed that wound’s edges did not approximate due to retraction of rectus in the cranial and caudal pole. Posterior layer was closed with running suture and double polypropylene mesh was placed. One year after surgery, patient remains without recurrences with a firm abdominal wall and recovery of life’s quality with radiologic confirmation images. Results Intestinal and Wall reconstruction in one step was feasible, although botulinum toxin injection did not provide benefits due a bilateral subcostal incision with significant muscle retraction. The 3D Planning allowed us to assess the degree of retraction of the musculature, much greater than what was appreciated in the physical examination. Conclusions The subcostal incision should be avoided in severe pancreatitis. Surgical planning with 3D technology is developing, allowing the entire anatomy to be assessed globally. 3D, useful tool for teaching, suggests that in subcostal laparotomies, it could help predicting that botulinum toxin would not be useful due to muscular retraction.