The prune-belly syndrome: a new and simplified technique of abdominal wall reconstruction.

PURPOSE: Various techniques of reconstruction have been developed to improve the cosmetic and functional status of the abdominal wall in the prune-belly syndrome. We describe a new extraperitoneal plication technique of abdominoplasty that is simplified in comparison to other established procedures in that it obviates the need for a fascial incision and/or entrance into the peritoneal cavity in patients who do not require a concurrent intra-abdominal procedure.

MATERIALS AND METHODS: Since 1980 this technique of abdominoplasty has been performed in 13 patients 9 months to 11 years old (mean age 3.8) at 2 institutions. Seven patients underwent surgery before age 2.5 years. Abdominal wall reconstruction was performed as an isolated extraperitoneal procedure in 5 patients, while 8 had concomitant procedures performed with the abdominoplasty, including bilateral Fowler-Stephens orchiopexy in 7, ureteral reconstruction/reimplantation in 5, excision of urachal diverticulum or cyst in 2, reduction cystoplasty in 1 and Tenckhoff catheter placement in 1.

RESULTS: In all cases the cosmetic result was excellent and satisfactory to patients, parents and surgeons. Since the first procedure was performed 17 years ago, only 1 patient has returned with abdominal wall laxity or bulging in the area of repair.

CONCLUSIONS: Our method of abdominal wall reconstruction in the prune-belly syndrome produces a cosmetically excellent and durable result. In contrast to other techniques of abdominoplasty, the need for a fascial incision and/or entrance into the peritoneal cavity is avoided. We believe that this modified procedure offers distinct technical and anatomical advantages over other existing techniques.