Various techniques of reconstruction have been developed to improve the cosmetic and functional status of the abdominal wall in the prune-belly syndrome. We describe a new extraperitoneal plication technique of abdominoplasty that is simplified in comparison to other established procedures in that it obviates the need for a fascial incision and/or entrance into the peritoneal cavity in patients who do not require a concurrent intra-abdominal procedure. Since 1980 this technique of abdominoplasty has been performed in 13 patients 9 months to 11 years old (mean age 3.8) at 2 institutions. Seven patients underwent surgery before age 2.5 years. Abdominal wall reconstruction was performed as an isolated extraperitoneal procedure in 5 patients, while 8 had concomitant procedures performed with the abdominoplasty, including bilateral Fowler-Stephens orchiopexy in 7, ureteral reconstruction/reimplantation in 5, excision of urachal diverticulum or cyst in 2, reduction cystoplasty in 1 and Tenckhoff catheter placement in 1. In all cases the cosmetic result was excellent and satisfactory to patients, parents and surgeons. Since the first procedure was performed 17 years ago, only 1 patient has returned with abdominal wall laxity or bulging in the area of repair. Our method of abdominal wall reconstruction in the prune-belly syndrome produces a cosmetically excellent and durable result. In contrast to other techniques of abdominoplasty, the need for a fascial incision and/or entrance into the peritoneal cavity is avoided. We believe that this modified procedure offers distinct technical and anatomical advantages over other existing techniques.