A male infant with Belly syndrome diagnosed at birth, with bilateral cryptorchidism treated by open surgery: bilateral orchidopexy at 2 months of age.
Location of testis required right orchiectomy.
The evaluation of the urinary tract at birth by renal ultrasound found left kidney with hydronephrosis grade II and absence of right kidney; the urethrocystogram showed megabladder and prolongation of the dome to the urachus.
We opted for a watchful waiting of the urinary tract.
At 8 years of age the abdominal wall was evaluated for reconstruction purposes, presenting short thorax, dystrophic abdomen with decreased muscle tissue wall and presence of skin folds.
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Under inhaled general anesthesia we performed abdominoplasty with Montfort technique, marking and ellipse under abdominal skin, from xiphoid appendix to consistent pituitary region.
This skin ellipse is de-epithelialized leaving a wide area of fatty tissue and fixed abdomen in the shape of the island ; the de-epithelialized layer of abdominal tissue leads the flap to the lateral edges.
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The postoperative course was uneventful.
In the clinical follow-up, at 14 years the patient had no urological complications, with negative urine cultures, serum creatinine of 0.8mg/dl and urodynamics with bladder capacity of 650ml (ideal= 500ml).
At 23 years of age, the patient has developed secondary sexual characters without urological or digestive symptoms.
At this time, he requests an abdominal aesthetic improvement.
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We performed abdominoplasty with Grazer access, preserving the authenticity and placing a 15x15 cm polypropylene mesh in the right hemiabdomen because it was considered the most affected side.
We fixed the excess skin and suture the edges of the abdominal flap to achieve wound closure.
The evolution was uneventful and the patient was discharged 3 days after surgery.
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In the review 1 year later he presented healed wounds, better abdominal wall tone and aesthetic improvement of the abdominal wall.
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Five years after surgery, we performed selective electromyography of the abdominal wall muscles with recording of monopolar electrode for anterior rectus muscles, external and internal oblique, for both sides, which confirmed a very poor anterior insertion pattern.
