Dynamic Abdominoplasty for Treatment of Prune Belly Syndrome

Introduction.  Prune belly syndrome (PBS), characterized by deficient abdominal wall musculature, intra-abdominal testes, and a dilated urinary collecting system, is an uncommon birth defect. Patients affected with PBS often have problems with chronic constipation, urinary retention, and respiratory infections, all related to an inability to raise intra abdominal pressure. In addition, the absent abdominal musculature has a significant impact on balance and ambulation. Traditional abdominoplasties provide only transient improvement in appearance and have minimal, if any, impact on function. We reviewed what we believe to be the first reported series of prune belly abdominoplasties, utilizing bilateral rectus femoris muscles transpositions, in order to evaluate outcomes with this novel procedure.

Methods.  A retrospective chart review of all patients undergoing prune belly abdominoplasties was undertaken. The absent abdominal wall musculature was reconstructed by superiorly transposing both rectus femoris muscles to the plicated abdominal fascia, based on their proximal blood supply. Records were reviewed for operative data, complications and functional outcomes.

Results.  Over a 16-year period 10 children (9 males, 1 female) with prune belly underwent treatment, 8 with rectus femoris transfers (two were noted to have rudimentary muscle; therefore, transfers were not performed). The mean surgical age was 36 months (range: 12-160 months), and the average hospital length of stay was 8.6 days. Total parental nutrition was given to all patients until resolution of the postoperative ileus, which was noted to be statistically significantly longer (P<0.5) in those undergoing simultaneous intra abdominal procedures (orchidopexy, nephrectomy, etc.). The mean length of follow up was just over 2 years. Three of 8 dynamic abdominoplasties had complications (urinary tract infection, chylous leak, and umbilical necrosis). Two patients were noted to have improvement on their chronic constipation, two patients had less frequent urinary tract infections, and most reported improved pulmonary status. Palpable postoperative abdominal muscular contractions and improvements in balance, posture and mobility, were noted in all patients undergoing muscle transpositions.

 

Conclusions.  A prune belly abdominoplasty, augmented with bilateral rectus femoris muscle transfers, appears to offer measurable functional benefits. In addition to enabling increases in intra abdominal pressure, this procedure conceptually provides a muscular balance to the spinal cord, which was clinically identifiable by improved posture and ambulation.