Highlights Giant omphalocele establish a therapeutic challenge to the surgeon - mainly because of the increased visceroabdominal disproportion and underlying malformations - and the best approach is still debatable worldwide. This is the second report on the literature and states the management of a child born with giant omphalocele that developed a very complex ventral hernia secondary to an unsuccessful attempt of closing the primary defect. It seems that the use of botulinum toxin agents in the abdominal wall is safe and effective in children with giant omphaloceles and it eliminates the use of a mesh even in more difficult cases. This technique seems safe and effective and it should be encouraged and best evaluated. It is time to start defining better criteria to categorize giant omphalocele in order to choose the best management for each patient.

Giant omphalocele (GO) is a complex condition to which many surgical treatments have been developed and yet, no consensus has been reached. The goal of this study is to describe the technique for primary repair of GO during the neonatal period using the BTA.