2018 Volume 54 Issue 4 Pages 942-945
It is difficult to obtain a satisfactory outcome in the repair of umbilical hernia with excess skin, because the excess tissue disturbs the satisfactory formation of a depression of the umbilicus. We performed a new surgical technique in three pediatric patients with such umbilical hernia. The technique consists of the following procedures: (1) The sac of the umbilical hernia was resected and the excess tissue under the skin around the umbilicus was trimmed off as thoroughly as possible, (2) the excess skin fold of the bottom of the umbilicus was then resected in a circular pattern and the defect in the skin was closed by purse-string suture, (3) the newly created bottom of the umbilicus was firmly anchored in the caudal rectus abdominis fascia by the same string of the purse-string suture to obtain a well-depressed umbilicus. One of these patients had a urachal remnant treated laparoscopically via the umbilical approach, and then the umbilical hernia was repaired by the method above. As the skin blood perfusion of the newly created bottom of the umbilicus was well maintained, there were no complications including skin necrosis or surgical site infection. The form of the umbilicus has remained in the well-depressed position more than 1 month after the operation. In addition, this new technique can be applied to patients with other diseases requiring surgery via the umbilical approach.
