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Background <p>Acute postoperative abdominal wall failure with recurrent evisceration is a&#xa0;rare but severe complication following emergency laparotomy. Progressive lateral wall contracture and loss of medial compliance may render repeated primary closures ineffective.</p> Methods <p>We describe the salvage management of a&#xa0;frail 66-year-old male with three episodes of recurrent postoperative evisceration after emergency laparotomy for an incarcerated inguinal hernia with ischemic small bowel. Bilateral transversus abdominis release (TAR) combined with retromuscular polypropylene mesh placement was performed, along with intraoperative botulinum toxin&#xa0;A (BTA) injection into the lateral abdominal wall.</p> Results <p>Transversus abdominis release restored medial compliance and allowed for anatomical midline reconstruction with wide retromuscular mesh overlap. Intraoperative BTA was used as a&#xa0;protective adjunct to decrease lateral muscle tension during early healing—not to facilitate closure. The patient’s postoperative course was uneventful with regard to abdominal wall integrity. At 6‑month follow-up, there was no recurrence, bulging, or chronic pain.</p> Conclusion <p>This case highlights the technical viability of combining anatomical reconstruction with functional modulation as a&#xa0;salvage strategy in highly selected patients with acute abdominal wall failure when repeated primary closure is unlikely to succeed and preoperative chemical component separation is not feasible. This observation is hypothesis generating only and should not be generalized beyond similar exceptional cases.</p>

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Salvage abdominal wall reconstruction for recurrent postoperative evisceration using transversus abdominis release and intraoperative botulinum toxin A

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Bartosz Molasy,
  • Emil Obrębski,
  • Maja Chowańska,
  • Rafał Kuchciński

摘要

Background

Acute postoperative abdominal wall failure with recurrent evisceration is a rare but severe complication following emergency laparotomy. Progressive lateral wall contracture and loss of medial compliance may render repeated primary closures ineffective.

Methods

We describe the salvage management of a frail 66-year-old male with three episodes of recurrent postoperative evisceration after emergency laparotomy for an incarcerated inguinal hernia with ischemic small bowel. Bilateral transversus abdominis release (TAR) combined with retromuscular polypropylene mesh placement was performed, along with intraoperative botulinum toxin A (BTA) injection into the lateral abdominal wall.

Results

Transversus abdominis release restored medial compliance and allowed for anatomical midline reconstruction with wide retromuscular mesh overlap. Intraoperative BTA was used as a protective adjunct to decrease lateral muscle tension during early healing—not to facilitate closure. The patient’s postoperative course was uneventful with regard to abdominal wall integrity. At 6‑month follow-up, there was no recurrence, bulging, or chronic pain.

Conclusion

This case highlights the technical viability of combining anatomical reconstruction with functional modulation as a salvage strategy in highly selected patients with acute abdominal wall failure when repeated primary closure is unlikely to succeed and preoperative chemical component separation is not feasible. This observation is hypothesis generating only and should not be generalized beyond similar exceptional cases.