THE PRUNE-BELLY-SYNDROME - A NEW AND SIMPLIFIED TECHNIQUE OF ABDOMINAL-WALL RECONSTRUCTION

Purpose: Various techniques of reconstruction have been developed to i mprove the cosmetic and functional status of the abdominal wall in the prune-belly syndrome. We describe a new extraperitoneal plication tec hnique of abdominoplasty that is simplified in comparison to other est ablished procedures in that it obviates the need for a fascial incisio n and/or entrance into the peritoneal cavity in patients who do not re quire a concurrent intra-abdominal procedure. Materials and Methods: S ince 1980 this technique of abdominoplasty has been performed in 13 pa tients 9 months to 11 years old (mean age 3.8) at 2 institutions. Seve n patients underwent surgery before age 2.5 years. Abdominal wall reco nstruction was performed as an isolated extraperitoneal procedure in 5 patients, while 8 had concomitant procedures performed with the abdom inoplasty, including bilateral Fowler-Stephens orchiopexy in 7, ureter al reconstruction/ reimplantation in 5, excision of urachal diverticul um or cyst in 2, reduction cystoplasty in 1 and Tenckhoff catheter pla cement in 1. Results: In all cases the cosmetic result was excellent a nd satisfactory to patients, parents and surgeons. Since the first pro cedure was performed 17 years ago, only 1 patient has returned with ab dominal wall laxity or bulging in the area of repair. Conclusions: Our method of abdominal wall reconstruction in the prune-belly syndrome p roduces a cosmetically excellent and durable result. In contrast to ot her techniques of abdominoplasty, the need for a fascial incision and/ or entrance into the peritoneal cavity is avoided. We believe that thi s modified procedure offers distinct technical and anatomical advantag es over other existing techniques.