Abdominoplasty in prune belly syndrome: Modifications in Monfort technique to address variable patterns of abdominal
Edwin A Smith1, Arun Srinivasan1, Hal C Scherz1
1Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
Insights
This study modified the Monfort abdominoplasty for prune belly syndrome (PBS), addressing unique abdominal wall laxity in patients. The modified technique resulted in improved contour and high patient satisfaction.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Reconstruction
- Congenital Abnormalities
Background:
- Abdominoplasty is crucial for managing prune belly syndrome (PBS).
- The standard Monfort procedure assumes symmetry, which is rarely present in PBS abdominal defects.
- Patient-specific anatomical differences necessitate tailored surgical planning.
Purpose of the Study:
- To describe modifications to the Monfort procedure for PBS abdominoplasty.
- To review outcomes of the modified procedure in correcting abdominal wall laxity.
- To improve anatomical positioning of the umbilicus.
Main Methods:
- Modified Monfort abdominoplasty in 17 patients (aged 2-9 years) with PBS or pseudoprune belly syndrome.
- Utilized diagnostic laparoscopy to map abdominal wall defects.
- Incorporated midline incisions, adjustable central plate width, and targeted fascial plication.
Main Results:
- All patients achieved improved abdominal wall contour and uniform correction of weakness.
- Mean follow-up was 5.5 years, with no revisions required.
- High satisfaction reported by all patients and parents.
Conclusions:
- The modified Monfort procedure effectively addresses individual abdominal muscular deficiencies in PBS.
- Surgical design is personalized based on patient-specific anatomical findings.
- This approach enhances outcomes for abdominoplasty in prune belly syndrome.
Introduction:
Abdominoplasty is an important component of the management of children with prune belly syndrome (PBS). While there are features of the abdominal defect in PBS which are common to all patients, there will be differences unique to each patient that should be taken into consideration in surgical planning. Specifically, we have come to realize that although the Monfort procedure assumes a symmetric pattern of abdominal wall laxity, this symmetry is rarely present.
Objective:
The aim of this report is to describe our modifications and review our outcomes for the Monfort procedure which more completely address correction of the abdominal wall laxity including both common and uncommon features while positioning the umbilicus to a more anatomically correct position (Figure).
Study Design:
Sixteen male patients with PBS and one female pseudoprune belly syndrome patient, aged 2-9 years, were treated at our institution between 2003 and 2014. Modifications incorporated into the abdominoplasty procedure for PBS applied to this study group included: 1) use of diagnostic laparoscopy to define the topography of the abdominal wall defect, 2) initial midline rather than elliptical skin incision to defer retailoring of the skin coverage until the final step of the procedure, 3) varying the width of the central plate to correct side to side asymmetry in redundancy, 4) plication of the central plate to reduce vertical redundancy and reposition the umbilicus, and 5) plication of focal areas of fascial weakness, most often in the flank region.
Results:
All patients have improved abdominal wall contour with a more uniform correction of areas of weakness at a mean follow-up of 5.5 years (range 18 months-11.5 years). All patients and parents indicate that they are very satisfied with the outcome of their procedures without any revisions being performed. This study is descriptive in nature and retrospective, with the patient population treated in a relatively uniform fashion that does not allow direct comparison with other techniques.
Conclusions:
The modified Monfort procedure recognizes the pattern of abdominal muscular deficiency unique to each patient and incorporates this information into the surgical design.
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