You have accessJournal of UrologyPediatrics: Reconstructive Surgery - Diversion, Endourology & Transplantation, Trauma1 Apr 20121206 ABDOMINOPLASTY IN PRUNE BELLY SYNDROME, MODIFICATIONS IN TECHNIQUE TO ADDRESS THE VARIABLE PATTERNS OF ABDOMINAL WALL WEAKNESS Edwin Smith, Arun Srinivasan, Andrew Kirsch, Hal Scherz, and Bruce Broecker Edwin SmithEdwin Smith Atlanta, GA More articles by this author , Arun SrinivasanArun Srinivasan Atlanta, GA More articles by this author , Andrew KirschAndrew Kirsch Atlanta, GA More articles by this author , Hal ScherzHal Scherz Atlanta, GA More articles by this author , and Bruce BroeckerBruce Broecker Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1473AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abdominoplasty is an important component of the management of children with prune-belly syndrome. Surgical tailoring of the abdominal wall results not only in an improved cosmetic appearance, but may also yield benefits of improved pulmonary, bowel and bladder function. While some features of the abdominal defect that are common to all patients, each patient possesses unique features that require consideration in surgical planning. We propose to our present our experience with this rare surgery and lessons we have learned. METHODS Patient information of children with prune-belly syndrome who underwent abdominoplasty in our institution between years 2001 to 2011 were collected. Indications for intervention, procedural details including incisions, adjunct procedures done and technique for dealing with the umbilicus were documented. Length of operative time, blood loss, complications and length of hospital stay were also collected. RESULTS 11 patients with prune-belly syndrome, ages 3 to 7 years of age underwent abdominoplasty using either the Ehrlich/Monfort techniques. In 9 patients, modifications in these techniques were applied to precisely address the pattern of abdominal wall laxity and properly position the umbilicus. These modifications included creation of a neoumbilicus, repositioning of the umbilicus using infraumbilical fascial tuck and differential tightening of the supraumbilical and infraumbilical components. In 1 patient, laparoscopy was used to assist repair. Abdominoplasty was performed concommittantly with other genitourinary procedures in 8 patients. Mean operative time is 251 minutes and mean hospital stay is 8 days. Immediate post operative outcome was satisfactory in all but one patient who had skin flap necrosis which improved in weeks. 2 children redeveloped supraumbilical abdominal reprotuberance and in 1 of them we felt this was due to progressive urinary tract dilation. After a median follow up of 5 years, 9 patients had stable satisfactory long term outcomes. CONCLUSIONS Abdominoplasty in prune-belly syndrome patients is not a single defined surgical procedure but rather a pot pourri of techniques that are modified to individual patient needs. Initial accurate assessment of morphological abnormalities and designing the intervention based on this assessment is the key to success. Infraumbilical Heinecke-Mikulicz technique of reconstruction is our favored method for repositioning umbilicus. Recurrent protuberance is a recognized complication and can occur years after repair. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e488 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edwin Smith Atlanta, GA More articles by this author Arun Srinivasan Atlanta, GA More articles by this author Andrew Kirsch Atlanta, GA More articles by this author Hal Scherz Atlanta, GA More articles by this author Bruce Broecker Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...