Background/purpose: Surgery of umbilical pathology requires restoration of a normal umbilical appearance. Also, the umbilicus is used increasingly as the entry site during laparoscopic surgery. However, conventional approaches leave obvious scars. A simple alternative approach that creates a natural-looking umbilicus is described.
Methods: The umbilicus is opened by creating 4 isosceles triangular skin flaps. Closure is by suture of the flap apex only, creating scaring that resembles a natural umbilicus.
Results: Between November 1996 and March 2003, this technique was used in 204 children with umbilical hernia, 2 children with a small omphalocele, 1 child with a patent omphalomesenteric duct, 2 children with a urachal abscess, and 7 children with an umbilical granuloma. Five children underwent initial trocar insertion during laparoscopic surgery via this approach. All procedures were performed uneventfully. Transient erythema of one flap occurred in 64 patients (29.2%). Infection developed in 10 patients (5.0%) but was treated with oral antibiotics. The postoperative umbilical appearance was satisfactory in all but 5 patients.
Conclusions: The 4-triangular-skin-flap approach is useful for umbilical diseases and laparoscopic umbilical port access.