抄録
Laparoscopic excision of urachal remnants is the standard approach because of its minimal invasiveness and favorable cosmetic outcomes. Although umbilical reconstruction is rarely required, a combined resection may create skin defects that demand specialized techniques, and reports in adults remain limited. Three female patients aged 31, 34, and 45 underwent simultaneous umbilical reconstruction following laparoscopic urachal resection at our institution in 2024. Preoperative computed tomography demonstrated periumbilical subcutaneous fat thickness of 14–24 mm. Reconstruction was performed using the Modified Kajikawa Method 1, thus creating a cutaneous tube from obliquely opposed flaps and securing it to the fascia with caudal Z-plasty or cruciate suturing to prevent a V-shaped deformity. At the 12–16-month follow-up, all patients maintained a stable umbilical morphology with a near-normal height of 11–13 mm and no flap necrosis. The ideal maximum umbilical height is 2 cm. In this technique, geometric calculation shows that a circular umbilicus reaches this height when each flap side measures approximately 3 cm. Because the cutaneous tube length was approximately equal to that of the one-side flap in all cases, patients with subcutaneous fat no thicker than this value were suitable. Although the method leaves a long vertical scar, it provides a good contour and it is useful in near-total umbilical loss.
Clinical course of the three cases before and after surgery.
Fullsize Image
Preoperative and postoperative images were acquired in the standing position, while all other images were obtained in the supine position. (a) Preoperative appearance. No signs of infection were observed in any of the cases. (b) Intraoperative view of the urachal remnant immediately after laparoscopic excision. (c) S-shaped skin-flap design based on the Kajikawa Method 1. (d) Appearance after wound closure and before bolster fixation. The caudal aspect of the umbilical fossa was closed in a cruciate fashion in Case 1, whereas Z-plasty was added in Cases 2 and 3.
