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Unique features of prune belly syndrome in laparoscopic surgery
Amulya K Saxena1, Olaf A Brinkmann
1Department of Pediatric Surgery, Medical University of Graz, Graz, Austria.
Insights
Laparoscopic abdominal access modifications are essential for children with prune belly syndrome undergoing the Fowler-Stephens procedure. These technical adjustments ensure successful surgical outcomes in patients with a floppy abdominal wall.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Urology
Background:
- Prune belly syndrome presents unique challenges for abdominal access in pediatric surgery.
- The Fowler-Stephens procedure is a critical intervention for these patients.
Purpose of the Study:
- To evaluate modifications for laparoscopic abdominal access in children with prune belly syndrome.
- To assess the feasibility and safety of the first stage Fowler-Stephens procedure in this patient population.
Main Methods:
- Eleven boys with prune belly syndrome underwent a transperitoneal laparoscopic bilateral first stage Fowler-Stephens procedure.
- Modified access techniques, insufflation pressures, and port stabilization were employed.
- Procedure duration and technical challenges were prospectively documented.
Main Results:
- All procedures were completed successfully without complications, with a mean operative time of 40 minutes.
- Open access was necessary for port insertion due to the floppy abdominal wall.
- Optimal insufflation pressure was 8 mmHg, and longer laparoscopic instruments were required.
Conclusions:
- Technical modifications are crucial for laparoscopic abdominal access in prune belly syndrome patients.
- Recommended modifications include open access, port fixation, and appropriate instrument length.
- These adaptations overcome technical hurdles associated with the floppy abdominal wall.
Background:
The aim of this study was to evaluate the laparoscopic abdominal access modifications in children with prune belly syndrome undergoing a first stage Fowler-Stephens procedure.
Study Design:
Eleven consecutive boys underwent a transperitoneal laparoscopic bilateral first stage Fowler-Stephens procedure. Patient age ranged from 1.5 to 3 years (mean age 2.2 years). In these patients, the floppy abdominal wall required a modified approach with regard to access technique, insufflation pressures, and work port stabilization methods. Duration of the procedures and intraoperative technical challenges encountered were prospectively documented.
Results:
Mean operative time was 40 minutes (range 30 to 75 minutes), and all procedures were completed without any complications. Forceful insertion of ports was not possible, and all ports were introduced under complete open access. Larger volumes of carbon dioxide were used in the initial part of our series, when the ports were not sutured to the abdominal wall. An abdominal pressure of 8 mmHg was maintained in all patients and was considered optimal for the procedures. Short laparoscopy instruments (240 mm) were unsuitable for the procedures and had to be replaced by longer instruments (310 mm or 430 mm).
Conclusions:
Technical modifications are required to the approach in laparoscopic abdominal access to overcome the challenges posed by the floppy abdominal wall in prune belly patients. Open access, suture fixation of the optic and work ports, use of threaded sleeve ports, and use of proper length of laparoscopy instruments are valuable modifications to overcome the technical hurdles posed by these patients.
