Efficacy and Safety of Botulinum Toxin Type A as a Preoperative Adjuvant in Primary Omphalocele Closure in the Pediatric Population: A Systematic Review

Abstract

Introduction: Giant omphalocele is a complex congenital malformation that poses a significant challenge in pediatric surgery due to viscero-abdominal disproportion, which hinders primary closure and increases the risk of complications such as abdominal compartment syndrome and cardiorespiratory compromise. In this context, botulinum toxin type A (BTA) has been proposed as a preoperative adjuvant strategy to improve surgical closure conditions. Objective: To evaluate the efficacy and safety of botulinum toxin type A as a preoperative adjuvant in the primary closure of giant omphalocele in the pediatric population. Materials and Methods: A systematic review was conducted following PRISMA guidelines, through database searches in Scopus, PubMed, SciELO, LILACS, and ProQuest. MeSH/DeCS descriptors and Boolean operators were used. Studies published within the last five years involving pediatric patients diagnosed with omphalocele who underwent preoperative BTA intervention were included. A total of 10 studies were selected for qualitative synthesis. Results: The included studies (mainly case reports and clinical series) showed that BTA infiltration into the abdominal wall increases muscular distensibility and facilitates primary closure in a high percentage of cases, reducing the need for staged techniques such as silo placement or mesh use. No significant systemic adverse effects were reported. The optimal effect was observed between 7 and 14 days post-infiltration. Conclusion: Botulinum toxin type A represents an effective and safe alternative as a preoperative adjuvant in the management of giant omphalocele in pediatric patients. However, the available evidence is limited, and higher-level studies are required to establish standardized protocols.