2019 年 35 巻 1 号 p. 230-237
During laparoscopic surgery, the thinnest part of the umbilicus is longitudinally incised to insert a trocar because this is the easiest route of access into the abdominal cavity. Following longitudinal incision of the bottom of the umbilicus, a deformation of the navel may become noticeable. This type of deformation is not observed when using a conventional incision, along the lower edge of the umbilicus. Deformation of the umbilicus is thought to be caused by a reduction in subcutaneous space due to suturing of the deep tissue and the turning-over skin at the time of incision becoming less invaded. It is also conceivable that contracture of the scar, in which the longitudinal wound at the bottom of the umbilicus shortens with the passage of time, causes the bulge in the umbilicus to stand out. If Z-plasty is used to perform umbilical closure in order to prevent scar contracture, it becomes easier for the skin at the edge of the wound to penetrate into the deeper portion of the wound. It is believed that the wound will not shrink following Z-plasty, even with the passage of time, thereby decreasing the incidence of deformation of the umbilicus.
Therefore, umbilical wound closure was performed using Z-plasty and patient satisfaction was evaluated 6 months after the operation. Of 102 patients questioned, 7.8 % responded that the shape of the umbilicus was improved following surgery, while 12.7 % acknowledged that there was some deformation of the navel. When the responses from patients who had undergone wound closure using Z-plasty were compared with those who had experienced the conventional wound closure method, umbilical wound closure using Z-plasty appeared to be useful for preventing deformity of the navel.