ABSTRACT
This video illustrates a laparoscopic-assisted modification of the Monfort abdominoplasty in a young male with prune belly syndrome (PBS). Laparoscopy was used to assess abdominal wall topography and guide reconstruction. Key technical steps include midline incision with deferred skin tailoring, central fascial plate resizing, vertical plication using a Heineke–Mikulicz closure for umbilical repositioning, and lateral fascial advancement to address horizontal redundancy. The patient recovered uneventfully with improved abdominal contour. This hybrid approach offers a safe and reproducible technique for individualized abdominal wall reconstruction.
OBJECTIVE
This video demonstrates a reproducible, laparoscopic-assisted modification of the Monfort abdominoplasty for reconstruction of abdominal wall laxity in PBS. The purpose of this video is to illustrate the technical modifications and operative pearls of this hybrid approach, emphasizing how laparoscopy enhances intraoperative assessment of abdominal wall anatomy and epigastric vasculature to facilitate individualized fascial reconstruction. The technique was developed to address the variable patterns of fascial deficiency and abdominal wall asymmetry commonly encountered in PBS while improving the safety and precision of reconstruction.[1,2]
METHODS
A 10-year-old male with history of PBS and renal transplant underwent hybrid laparoscopic-assisted abdominoplasty. A 5-mm supraumbilical trocar was placed, and pneumoperitoneum allowed visualization of fascial deficiencies and mapping of the epigastric vessels to avoid inadvertent transection during the skin flaps creation[3] [Figure 1].
Figure 1.
Port placement strategy and pneumoperitoneum enabling intra-abdominal topographic assessment
A midline incision was performed, and skin flaps were elevated, with skin tailoring deferred until the end of the procedure to avoid a premature asymmetric reconstruction. The epigastric vessels were used as landmarks to guide fascial incision. The central fascial plate was resized to correct asymmetry. Vertical redundancy was addressed by a midline infraumbilical division and Heineke–Mikulicz closure, facilitating anatomic repositioning of the umbilicus.[1,2,4]
Horizontal laxity was corrected by medial advancement and overlap of the lateral abdominal fascia. Skin redundancy was then excised and closed in the midline.[5] Two subcutaneous drains and a suprapubic catheter were placed.
RESULTS
Operative time was 5 h with an estimated blood loss of 50 mL. The patient tolerated the procedure well. No complications occurred, and drains were removed before discharge. The suprapubic catheter was placed to provide temporary low-pressure bladder drainage and protect the transplanted kidney during the immediate postoperative period while the abdominal wall reconstruction healed. The catheter was clamped one week after surgery. Once the patient resumed spontaneous voiding, the catheter was removed at the 4-week follow-up appointment after confirming satisfactory bladder emptying. Early postoperative evaluation demonstrated improved abdominal contour and stability.
CONCLUSIONS
Laparoscopic-assisted modification of the Monfort technique provides several potential advantages over traditional approaches. Enhanced visualization of abdominal wall anatomy and epigastric vasculature allows more precise, patient-specific fascial reconstruction while minimizing the risk of vascular injury during flap creation. The technique facilitates correction of both vertical and horizontal abdominal wall redundancy and accommodates the variable patterns of fascial laxity characteristic of PBS. In addition to improving anatomic visualization, laparoscopy provides real-time information that informs intraoperative decision-making and allows reconstruction to be tailored to the patient’s unique pattern of abdominal wall deficiency.
By combining laparoscopic guidance with established reconstructive principles, this hybrid approach offers a safe, reproducible method that may improve reconstructive precision, abdominal wall stability, contour symmetry, and cosmetic outcomes.[1,3,6]
Conflicts of interest
There are no conflicts of interest.
Video available on: www.indianjurol.com
Funding Statement
Nil.
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