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      Abdominoplastia por plicatura anterior longitudinal na síndrome de prune belly: experiência inicial do hospital municipal Jesus Translated title: Abdominoplasty by longitudinal anterior plicature in prune belly syndrome: preliminary experience in hospital municipal Jesus

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          Abstract

          OBJETIVO: Apresentar os resultados iniciais com o uso da técnica de abdominoplastia longitudinal anterior por plicatura parietal descrita por Furness et al (1998) no Hospital Municipal Jesus. MÉTODO: Descrevemos as características e resultados dos primeiros pacientes tratados em nosso serviço, inclusive duas modificações adotadas com relação à técnica descrita, a saber, a exploração retroperitoneal sistemática para cura da criptorquia bilateral simultânea à abdominoplastia e a celiotomia "de segurança" para todos os pacientes operados. RESULTADOS: O seguimento dos pacientes foi de 1,5 ano, 15 meses e 10 meses, respectivamente. Foi possível demonstrar que a técnica adotada foi de fácil execução e pequena morbidade, com resultados estéticos satisfatórios, grande melhora das condições psicológicas e do convívio social para os pacientes desde o pós-operatório imediato, melhora da constipação crônica, capacidade aeróbica e postura. Quanto às repercussões urodinâmicas, aguardamos reavaliação a longo prazo, para conclusões mais efetivas. CONCLUSÃO: A abdominoplastia longitudinal anterior é uma técnica de fácil execução e segura para o tratamento da síndrome de prune belly e melhora a capacidade funcional muscular abdominal. Tem conseqüências urodinâmicas, que necessitam de avaliação após longo prazo.

          Translated abstract

          BACKGROUND: Our aim is tis present initial results with the anterior longitudinal abdominoplasty, described by Furness et al (1998) in three patients operated at the Hospital Municipal Jesus, Rio de Janeiro, Brazil. METHODS: We describe pre and post-operative clinical data and surgical results for the first three patients submitted to surgical treatment and describe two technical modifications: retroperitoneal systematic exploration simultaneously to parietal abdominoplasty to treat cryptochid testicles and "for safety" celiotomy to protect abdominal viscera. RESULTS: Follow up 1,5 year, 15 and 10 months for patients 1, 2 and 3, respectivelly. We could demonstrate that anterior longitudinal abdominoplasty is a safe and easily performed surgical technique, with good aesthetic results and significant psychological and social improvement. Chronic constipation, aerobic capacity and postural changes are also ameliorated. Regarding urodynamic repercussions we think that a longer period of observation is necessary to reach any definitive conclusions. CONCLUSIONS: Anterior longitudinal abdominoplasty is an effective and safe technique to treat prune belly syndrome patients and ameliorates functions of the abdominal parietes. It has urodynamic consequences that need long-term follow-up.

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          Congenital anterior abdominal wall defects in England and Wales 1987-93: retrospective analysis of OPCS data.

          Analysis of incidence and characteristics of congenital abdominal wall defects, with special reference to the differences between the incidence of gastroschisis and exomphalos (omphalocele). Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate exomphalos and gastroschisis) and the National Congenital Malformation Notification Scheme. England and Wales, 1987 to 1993. 1043 congenital anterior abdominal wall defects were notified within the seven year study period. Of these, 539 were classified as gastroschisis, 448 as exomphalos, 19 as "prune belly syndrome," and 37 as "unclassified." Gastroschisis doubled in incidence from 0.65 in 1987 to 1.35 per 10,000 total births in 1991, with little further change; the incidence of exomphalos decreased from 1.13 to 0.77 per 10000 births. The overall incidence of notified congenital abdominal wall defects was 2.15 per 10000 total births. Gastroschisis was associated with a lower overall maternal age than exomphalos and with a significantly lower proportion of additional reported congenital malformations (5.0%) than in the cohort with exomphalos (27.4%) (odds ratio 0.14, 95% confidence interval 0.09 to 0.22; P < 0.001). The sex ratio of the two cohorts was the same. The incidence of gastroschisis and exomphalos was higher in the northern regions of England than in the south east of the country. The national congenital malformation notification system showed an increasing trend in the incidence of fetuses born with gastroschisis and a progressive decreasing incidence of exomphalos in England and Wales between 1987 and 1993. Although the reasons for this are likely to be multifactorial, a true differential change seems likely. The observed increase in incidence of gastroschisis relative to exomphalos and the differentiation in maternal age have implications for resource management within the NHS and warrant further epidemiological monitoring. Regional differences may be due to a dietary or environmental factor, which requires further study.
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            Total surgical reconstruction for patients with abdominal muscular deficiency ("prune-belly") syndrome.

            In the past decade, seven children with the prune-belly syndrome have been seen. Their management has consisted of immediate high tubeless urinary diversion, usually pyelostomy. Thereafter, total reconstruction has been carried out, preferably at one stage. This consists of (1) bilateral shortening, tapering and reimplantation of the ureters, (2) reduction cystoplasty, (3) bilateral orchiopexy, and (4) excision of that part of the abdominal wall that is most redundant and least endowed with musculature. This early effort at mechanical reconstruction has led to gratifying progress in six of the seven children.
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              The orthopaedic manifestations of prune-belly (Eagle-Barrett) syndrome.

              Forty children were managed for prune-belly syndrome between 1979 and 1989, and twenty-five of them had musculoskeletal abnormalities. The musculoskeletal abnormalities were primary in twenty-two children, secondary to renal osteodystrophy in one, and both primary and secondary to renal osteodystrophy in two. Thirteen children had marked abnormality of the hip, and congenital dislocation was typically resistant to conventional treatment. Scoliosis was seen in seven patients. Pectus excavatum (a chest-wall deformity) was seen in eleven patients, including five of the six who had an idiopathic-like curve. Although prune-belly syndrome is uncommon, the diagnosis necessitates a thorough orthopaedic evaluation because of the high prevalence of associated musculoskeletal abnormalities.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Rev. Col. Bras. Cir.
                Colégio Brasileiro de Cirurgiões (Rio de Janeiro )
                1809-4546
                June 2001
                : 28
                : 3
                : 173-179
                Affiliations
                [1 ] Universidade Federal Fluminense Brazil
                [2 ] Hospital Municipal Jesus
                [3 ] Hospital Municipal Jesus
                [4 ] Hospital Municipal Jesus
                Article
                S0100-69912001000300004
                10.1590/S0100-69912001000300004
                d5f3753b-5541-4fee-877e-77c79fc19838

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-6991&lng=en
                Categories
                SURGERY

                Surgery
                Prune belly syndrome,Abdominoplasty,Síndrome de Prune Belly,Abdominoplastia
                Surgery
                Prune belly syndrome, Abdominoplasty, Síndrome de Prune Belly, Abdominoplastia

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