1
|
Martin AM, Møller MP. Sister Mary Joseph nodule. Ugeskr Laeger 2024; 186:V07230477. [PMID: 38445337 DOI: 10.61409/v07230477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Sister Mary Joseph nodule (SMJN) is a rare clinical finding in patients with metastatic adenocarcinoma. This is a case report of a 69-year-old man, who presented with a cutaneous element by his umbilicus at his GP. He was referred to a dermatologist, then a plastic surgeon. The element was a metastasis from adenocarcinoma originating from his caecum. It is important for doctors to know of SMJN as a rare presentation of metastatic cancer, and to clinically examine the patient for an abdominal starting point, when presented with a cutaneous tumour at the position of the umbilicus.
Collapse
Affiliation(s)
- Anine Maria Martin
- Plastikkirurgisk Afdeling, Københavns Universitetshospital - Herlev Hospital
| | | |
Collapse
|
2
|
Hawariat BYW, Ali AO, Gebreselassie HA. Ileal prolapse through patent omphalomesenteric duct in a two year-old boy: a case report. J Med Case Rep 2024; 18:67. [PMID: 38311773 PMCID: PMC10840172 DOI: 10.1186/s13256-024-04370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/06/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Patent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13-0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology. CASE PRESENTATION 2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day. CONCLUSION Prolapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered.
Collapse
|
3
|
Costantini C, Pani E, Negri E, Beretta F, Bisoffi S, Fati F, Mazzero G, Revetria C, Sadri HR, Ciardini E. Is transumbilical laparoscopic-assisted appendectomy feasible for complicated appendicitis? A single-center experience. Pediatr Surg Int 2024; 40:50. [PMID: 38308698 DOI: 10.1007/s00383-023-05624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Transumbilical laparoscopic-assisted surgery (TULS) mixed benefits of laparoscopic and open surgeries. Transumbilical laparoscopic-assisted appendectomy (TULAA) is a well-known procedure, accepted and currently used by pediatric surgeons for treatment of uncomplicated appendicitis (UA). There is no current agreement in its use for the complicated appendiceal infections (CA). We reported our results using TULAA for both UA and CA. METHODS We retrospectively collected TULAA performed between April 2017 and April 2022. Appendicitis were classified in UA and CA. We analyzed conversion rate, operative time, length of stay, surgical site infections (SSIs) rate, postoperative intra-abdominal abscess and costs. RESULTS Over 5 years, 316 children underwent TULAA. Conversion rate was 3%. Mean age at surgery was 9.36 years (IQR 2-16). Forty-nine appendicitis were CA. Operative time and hospital stay was higher in CA than in UA group (38.33 vs. 60.73 min, p < 0.00001; 4 vs. 7 days, p < 0.00001). SSIs rate showed no statistically significant difference between two groups. Incidence of postoperative intra-abdominal collections was 11% in CA and 1% in UA. TULAA's cost was 192.07 €. CONCLUSION In our series, TULAA seems to be safe, feasible and cost-effective for both uncomplicated and complicated appendicitis, with no disadvantage in terms of outcomes compared to what is reported in literature for CLS.
Collapse
Affiliation(s)
- Chiara Costantini
- Pediatric Surgery, Woman and Child Health Department, Hospital of Padua, Padua, Italy.
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy.
| | - Elisa Pani
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | - Elisa Negri
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | - Fabio Beretta
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | | | - Federica Fati
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | | | | | - Hamid R Sadri
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | | |
Collapse
|
4
|
Tambasco D, Albanese R, Tomaselli F, Parodi PC. Reply: "Indications, outcomes, and complications of neoumbilical reconstruction: A systematic review". J Plast Reconstr Aesthet Surg 2024; 89:53-54. [PMID: 38142621 DOI: 10.1016/j.bjps.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023]
Affiliation(s)
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy.
| | | | | |
Collapse
|
5
|
Steen CJ, Wei MYK, Vadakkenchery Varghese E, Asghari-Jafarabadi M, Sansom W, Balakrishnan V, An V, Chandra R. Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study. ANZ J Surg 2024; 94:187-192. [PMID: 37749845 DOI: 10.1111/ans.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). METHODS A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. RESULTS Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. CONCLUSION There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.
Collapse
Affiliation(s)
- Christopher J Steen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew Y K Wei
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | | | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy Sansom
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vinna An
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Chen F, Zeng Y, Yue LL, Xie MF, Liu HJ. Patent vitellointestinal duct with ileal prolapse in a newborn: A case report and literature review. Medicine (Baltimore) 2024; 103:e36919. [PMID: 38241543 PMCID: PMC10798687 DOI: 10.1097/md.0000000000036919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
RATIONALE Patent vitellointestinal duct is the most common omphalomesenteric duct anomaly to present with symptoms. PATIENT CONCERNS A 10-day-old child presented with increase in the size of a polypoidal lesion into a large, "Y"-shaped reddish, prolapsing lesion, discharging gaseous, and fecal matter at her umbilicus. A laparoscopic exploration was performed, followed by wedge resection and anastomosis. No complications occurred during postoperative follow-up. DIAGNOSES A patent vitellointestinal duct with ileal prolapse. INTERVENTIONS The resection of extended intraperitoneal intestinal tube was performed. OUTCOMES During the follow-up 3 months after surgery, the umbilical cord of the child healed well after surgery. LESSONS Timely surgical treatment can minimize the occurrence of complications, and the overall prognosis is good after surgery.
Collapse
Affiliation(s)
- Feng Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| | - Yong Zeng
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| | - Lin-Lin Yue
- Department of Intensive Care Unit, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ming-Feng Xie
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| | - Hai-Jin Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| |
Collapse
|
7
|
Guiotto M, Oranges CM, Cherubino M, Maruccia M, Tedeschi P, Kalbermatten DF, Raffoul W, di Summa PG. Indications, outcomes, and complications of neoumbilical reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2024; 88:83-98. [PMID: 37972443 DOI: 10.1016/j.bjps.2023.10.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/12/2022] [Accepted: 10/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Neoumbilicoplasty aims to reconstruct an aesthetically pleasing new umbilicus following agenesis, malignancy, anatomical distortion, or umbilicus loss. Despite the wide variety of surgical techniques described, literature is scarce when it comes to standardized categorization of these as well as the clear definition of patients' selections, specific indications, final outcomes, and possible complications. According to available literature, this work aims to evaluate different surgical approaches, and correlate them to specific surgical needs, to simplify the surgical choice and patient management. METHODS A systematic review was performed in December 2020 in PubMed, Web of Science, and MedLine Ovid databases according to the PRISMA guidelines. RESULTS A total of 41 studies and 588 patients were finally included. On the basis of the evidence of the literature collected, we divided the studies into four groups according to the neoumbilicoplasty techniques: single suture or purse-string suture, single flap, multiple flap, and skin graft. Patients' surgical comorbidities, neoumbilicoplasty indications, and aesthetic and surgical outcomes were investigated. Direct suture and single and multiple flap techniques assured overall, satisfactory cosmetic outcomes with a low rate of surgical complications. Whereas suture-only techniques were chosen mostly by general surgeons/urologists in laparoscopic surgery, the single flap was the preferred method to reconstruct the umbilicus in open abdominal surgery or combined abdominoplasty with herniorrhaphy. Multiple flap and skin grafts were adopted in abdominoplasty-related umbilicus reconstruction, although the latter option showed impactful aesthetic and surgical complications. CONCLUSIONS Umbilicoplasty can assure generally pleasant aesthetic outcomes with relatively low complication rates. Indications for specific techniques correspond to different patient populations and surgical scenarios.
Collapse
Affiliation(s)
- M Guiotto
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - C M Oranges
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hopitaux Universitaire Geneve (HUG), Geneve, Switzerland
| | - M Cherubino
- Plastic and Reconstructive Surgery, Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
| | - M Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari 70124, Italy
| | - P Tedeschi
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari 70124, Italy
| | - D F Kalbermatten
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hopitaux Universitaire Geneve (HUG), Geneve, Switzerland
| | - W Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - P G di Summa
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
| |
Collapse
|
8
|
Tambasco D, Tomaselli F, Albanese R, Nele G, Parodi PC. REPLY: Modified diamond-shaped umbilicoplasty in abdominoplasty. J Plast Reconstr Aesthet Surg 2024; 88:328-329. [PMID: 38061256 DOI: 10.1016/j.bjps.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 01/02/2024]
Affiliation(s)
| | | | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Hospital of Udine, University of Udine, Udine, Italy.
| | - Gisella Nele
- "Body&Mind Center", Riviera di Chiaia Napoli 127, Napels 80122, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
| |
Collapse
|
9
|
Miyazaki Y, Morimoto Y, Hashimoto Y, Michiura T, Hayashi N, Yamabe K. [A Case of Cecal Cancer Diagnosed from Sister Mary Joseph's Nodule]. Gan To Kagaku Ryoho 2023; 50:1828-1830. [PMID: 38303221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A metastatic tumor of the umbilicus is called"Sister Mary Joseph's nodule", and patients with this tumor show a poor prognosis. Sister Mary Joseph's nodule is a rare occurrence, and there are few case reports. We report a case of cecal cancer first presented with the metastatic tumor in the umbilicus. A 90-year-old woman, complained umbilical induration and foul-smelling discharge, had been treated as omphalitis for 2 months. Because her symptom didn't improve, biopsy of the umbilical tumor was performed, and the findings revealed an adenocarcinoma. She was referred to our hospital. Abdominal CT showed wall thickening in the cecum, and multiple liver metastases. Therefore, we performed lower gastrointestinal endoscopy, which revealed a cecal tumor. We performed biopsy of the tumor and the findings were consistent with adenocarcinoma. Based on these results, we diagnosed the umbilical tumor as a metastasis from the colorectal cancer. Umbilical resection and ileocecal resection were performed, and multiple peritoneal metastases was detected. Post operative course was uneventful, she died 11 months after surgery. Umbilical metastases may worsen the patient's quality of life; thus, the local resection of umbilicus was recommended positively.
Collapse
|
10
|
Kimura S, Teranishi F, Katada T, Koide S, Shibata T, Nakai N, Matsuo Y. [Peritoneal Mesothelioma Diagnosed with a Sister Mary Joseph's Nodule]. Gan To Kagaku Ryoho 2023; 50:1659-1661. [PMID: 38303374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
In August 2022, a 59-year-old female noted a mass in her umbilicus and sought evaluation at Toyokawa City Hospital. Abdominal computed tomography(CT)scan revealed a 1.6 cm mass in the umbilical region, ascites in the pelvis, and increased absorption in the omentum. Peritoneal dissemination of the carcinoma and Sister Mary Joseph's nodule due to an unknown primary tumor were suspected because no abnormalities were detected during upper and lower gastrointestinal endoscopy. She underwent an umbilical lumpectomy and diagnostic laparoscopy to establish a definitive diagnosis. The surgical findings included numerous white nodules throughout the abdominal cavity. The umbilical mass and omental white nodules were resected. A final diagnosis of epithelial peritoneal mesothelioma was made based on the histopathologic examination. In general, peritoneal mesothelioma has a poor prognosis, and early treatment is essential; however, making a timely definitive diagnosis is difficult. Peritoneal mesothelioma should be included in the differential diagnosis for a patient with unexplained ascites and abdominal pain. Diagnostic laparoscopy and biopsy will facilitate the establishment of a definitive diagnosis.
Collapse
Affiliation(s)
- Sho Kimura
- Dept. of Surgery, Narita Memorial Hospital
| | | | | | | | | | | | | |
Collapse
|
11
|
Darwish A, Tawfik M, Gaflan A, Darwish D. Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial. Sultan Qaboos Univ Med J 2023; 23:455-462. [PMID: 38090239 PMCID: PMC10712379 DOI: 10.18295/squmj.5.2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aimed to describe a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with an infra-umbilical incision in gynaecologic laparoscopy. Methods Between August 2019 and March 2021, 110 patients subjected to the direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision, whereas group B comprised 55 cases of a modified, curved, longitudinal, deep, bidirectional, intra-umbilical incision. Afterwards, intraoperative and postoperative assessments were performed. Results The increase in the numbers of parity, gravidity and previous caesarean sections was found to be statistically significant; a smaller number of infertility complaints were observed in group B. Similarly, group B expressed a statistically significant less peri-trocar CO2 leakage (46 [83.6%] patients versus 28 [50.9%] patients) and more tightness of the primary portal entry (45 [81.8%] patients versus 30 [54.5%] patients) when compared to group A throughout the whole operation. After a one-month follow-up, a statistically significant (P = 0.029) decrease in the Observer Scar Assessment Scale and Patient Scar Assessment Scale scores in group B (10.4 ± 4.2 and 11.8 ± 4.3, respectively), demonstrating better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8, respectively). Conclusion Performing a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for the insertion of a primary laparoscopic trocar (i.e. Darwish laparoscopic entry) is a simple and fast step that results in the elimination of intraoperative gas leakage and trocar slippage without the need for any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses when compared to an infra-umbilical incision.
Collapse
Affiliation(s)
- Atef Darwish
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Mohammad Tawfik
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Amal Gaflan
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Dina Darwish
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| |
Collapse
|
12
|
Chakari R, Razavi D, Huss F. [Umbilical pilonidal sinus - a rare disease?]. Lakartidningen 2023; 120:23082. [PMID: 37818822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Umbilical pilonidal sinus is a rare diagnosis which is characterized by an inflammatory granulomatous reaction to hair shafts penetrating the epidermis. It is most often seen in adolescent male with a hairy abdomen. The patients often present with a history of pain and umbilical discharge. Conservative treatment with hair extraction and personal hygiene is prioritized and surgery is only recommended in recurrent cases. Here one such case is presented, which was resistant to conservative treatment and where surgical excision and primary repair was indicated. No recurrence was observed 6 months postoperatively.
Collapse
Affiliation(s)
- Rehan Chakari
- leg läkare, VO plastikkir-urgi och käkkirurgi, Akademiska sjukhuset, Uppsala
| | - Dan Razavi
- överläkare, plastik- och allmänkirurgi, kirurgkliniken, Lasarettet i Enköping
| | - Fredrik Huss
- docent, överläkare, VO plastikkirurgi och käkkirurgi, Akademiska sjukhuset, Uppsala; Uppsala universitet
| |
Collapse
|
13
|
Abstract
BACKGROUND The aim in umbilicoplasty is to obtain a scar that is less visible, the appropriate navel shape and depth. In our study, we aimed to achieve a more natural and younger appearance of the navel which significantly affects the aesthetic result after abdominoplasty. Modification of diamond-shaped umbilicoplasty technique and clinical results were evaluated. PATIENTS AND METHODS Fifty-three patients were included in the study. Modified diamond-shaped umbilicoplasty was performed in 21 patients, and diamond-shaped umbilicoplasty was performed in 32 patients. Demographic data, complications, revision surgery, and follow-up periods of the patients were reviewed retrospectively. Different from the standard technique, we deepithelialized the diamond-shaped skin over the abdomen flap and designed four triangular flaps. Then, the navel was inset over these four flaps. RESULTS Forty-six (86.8%) of the patients were females and 7 (13.2%) were males, with a mean age of 39.49 ± 9.18 years, ranging from 22 to 57 years. Complications were occurred in 9 patients in total. There was no difference between groups in complication rates. The mean VAS value of the patients in the MDSU group was 9.48 ± 0.75, it was 8.28 ± 0.99 in the DSU group, and the difference was statistically significant (p:0.001). The mean age of the MDSU group was found to be significantly higher than the DSU group (p:0.008). The BMI of the MDSU group was found to be significantly higher between two groups (p:0.009). DISCUSSION In our study, there was no difference between the complication rates of the two techniques. Therefore, MDSU is a reliable technique. High VAS score of the patients of MDSU was statistically significant. This shows that this modification provides good aesthetic results. CONCLUSION Modified diamond-shaped umbilicoplasty is easy to perform and provides better aesthetic results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Vasfi Çelik
- Op Dr Vasfi Çelik Aesthetic Plastic Surgery Clinic, Mersin, Turkey
| | - Yavuz Tuluy
- Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa Turgutlu State Hospital, 45000, Turgutlu, Manisa, Turkey.
| | - Emin Sır
- Department of Plastic, Reconstructive and Aesthetic Surgery, İzmir Kavram Vocational School, İzmir, Turkey
| |
Collapse
|
14
|
Tokumoto H, Akita S, Kosaka K, Nakamura R, Yamamoto N, Kubota Y, Mitsukawa N. Fascia turnover procedure at breast reconstruction using free TRAM flap for decreasing umbilical migration. J Plast Reconstr Aesthet Surg 2023; 85:120-126. [PMID: 37482025 DOI: 10.1016/j.bjps.2023.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The ideal umbilical position is midway between the two iliac crests. Some patients complained that the umbilicus position shifted from the midline after the breast reconstruction with a free muscle-sparing transverse rectus abdominis musculocutaneous (MS-TRAM) flap. We considered that the fascia of the external oblique muscle could be applied to the rectus abdominis fascia defect. This study aimed to introduce this "fascia turnover procedure" and compare the umbilical position in this procedure with that in primary fascial closure for the MS-TRAM flap of breast reconstruction. METHODS A total of 152 patients were enrolled (80 patients with fascia turnover (+) vs. 72 patients (-)). The patients' demographics were compared. Horizontal distances (right side: a; left side: b) were measured bilaterally from the lateral abdominal wall to the center of the umbilicus. Frontal abdominal photographs were taken preoperatively (a1, b1) and postoperatively (a2, b2). The rate of umbilical migration (= | (a1 - b1) / (a1 + b1) - (a2 - b2) / (a2 + b2) | × 100%) was calculated. Because the aponeurosis of the external oblique muscle is confirmed in front of the lateral side of the anterior rectus sheath, this procedure could be performed in cases with a medial defect. RESULTS No significant differences in the patients' demographics, including abdominal bulging rates and abdominal wall defect widths were observed between the two groups. The rate of umbilical migration showed a significant difference (median 1.78% vs. 3.70%, P < 0.001). CONCLUSIONS This procedure could decrease the rate of umbilical migration.
Collapse
Affiliation(s)
- Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Japan.
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Japan
| | - Kentaro Kosaka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Japan
| | - Rikiya Nakamura
- Department of Breast Surgery, Chiba Cancer Center Hospital, Japan
| | - Naohito Yamamoto
- Department of Breast Surgery, Chiba Cancer Center Hospital, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Japan
| |
Collapse
|
15
|
Pu LLQ, Firriolo JM. Invited Discussion on: Modified Diamond-Shaped Umbilicoplasty in Abdominoplasty. Aesthetic Plast Surg 2023; 47:1920-1921. [PMID: 37256296 DOI: 10.1007/s00266-023-03375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Lee L Q Pu
- Division of Plastic and Reconstructive Surgery, University of California Davis, 2335 Stockton Blvd, Room 6008, Sacramento, CA, 95817, USA.
| | - Joseph M Firriolo
- Division of Plastic and Reconstructive Surgery, University of California Davis, 2335 Stockton Blvd, Room 6008, Sacramento, CA, 95817, USA
| |
Collapse
|
16
|
Muhialdeen AS, Baba HO, Salih AM, Fathalla BL, Latif S, Hasan SJ, Mohammed RO, Hamasalih HM, Karim SO, Ali HO, Mohammed SH, Kakamad FH, Hassan MN. Non-operative management of umbilical pilonidal sinus: One more step towards ideal therapy. Int Wound J 2023; 20:2505-2510. [PMID: 36726041 PMCID: PMC10410359 DOI: 10.1111/iwj.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023] Open
Abstract
There are controversies regarding the management of umbilical pilonidal sinuses. The current study aims to report on the efficacy of a non-operative, umbilical conserving procedure in the treatment of umbilical pilonidal sinus. This is a prospective, single cohort study. The cases were managed in a single private practice center. Patients were assessed and managed throughout the previous nine years (from January 2013 to June 2022). The required information was obtained from the center's medical database. The current study included 114 patients. There were 82 (71.9%) male patients. The patients' ages varied from 14 to 56 years (mean = 23.24). The umbilicus was retracted under local anesthesia. The sinuses were cleaned with povidone-iodine. Following the drying of the cavity, the mixture was put in the umbilicus, and the area was dressed. The amount of mixture was determined by the size of the cavity. Following treatment, the patients were directly discharged home with instructions to remove all hair from the chest and abdomen and keep the dressing dry for three days. After three days, the patients were advised to use a clean cotton swab to remove the injected mixture. Recurrence was reported in 5 cases (4.4%). The current technique might be used effectively in the treatment of umbilical pilonidal sinus. It is an umbilical preserving technique with a minimal recurrence rate.
Collapse
Affiliation(s)
- Aso S. Muhialdeen
- Surgical DepartmentSulaimani Teaching HospitalSulaimani, KurdistanIraq
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
- Kscien OrganizationHamdi Str, Azadi MallSulaimani, KurdistanIraq
| | - Hiwa O. Baba
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
- Kscien OrganizationHamdi Str, Azadi MallSulaimani, KurdistanIraq
| | - Abdulwahid M. Salih
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
- College of MedicineUniversity of Sulaimani, Madam Mitterrand StreetSulaimani, KurdistanIraq
| | - Bahman Latif Fathalla
- Surgical DepartmentSulaimani Teaching HospitalSulaimani, KurdistanIraq
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
| | - Shaban Latif
- Surgical DepartmentSulaimani Teaching HospitalSulaimani, KurdistanIraq
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
| | | | | | - Hussein M. Hamasalih
- Surgical DepartmentSulaimani Teaching HospitalSulaimani, KurdistanIraq
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
| | - Sanaa O. Karim
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
- College of NursingUniversity of Sulaimani, Madam Mitterrand StreetSulaimani, KurdistanIraq
| | - Halkawt Omer Ali
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
| | | | - Fahmi H. Kakamad
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
- Kscien OrganizationHamdi Str, Azadi MallSulaimani, KurdistanIraq
- College of MedicineUniversity of Sulaimani, Madam Mitterrand StreetSulaimani, KurdistanIraq
| | - Marwan N. Hassan
- Smart Health TowerMadam Mitterrand StreetSulaimani, KurdistanIraq
- College of NursingUniversity of Sulaimani, Madam Mitterrand StreetSulaimani, KurdistanIraq
| |
Collapse
|
17
|
Khan NF, Khatoon MA, Naeem S. Umbilical Pilonidal Sinus. J Coll Physicians Surg Pak 2023; 33:1077. [PMID: 37691377 DOI: 10.29271/jcpsp.2023.09.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/07/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Nawaid Farooque Khan
- Department of General Surgery, Sindh Government Qatar Hospital, Karachi, Pakistan
| | - Malik Amna Khatoon
- Department of General Surgery, Sindh Government Qatar Hospital, Karachi, Pakistan
| | - Sarosh Naeem
- Department of General Surgery, Sindh Government Qatar Hospital, Karachi, Pakistan
| |
Collapse
|
18
|
Warshafsky C, Corran B, Glen P, Busca A, Singh SS. Management of a large umbilical endometrioma. Am J Obstet Gynecol 2023; 229:333-336. [PMID: 36933685 DOI: 10.1016/j.ajog.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Chelsie Warshafsky
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Brigitte Corran
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Glen
- Departments of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Aurelia Busca
- Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sukhbir Sony Singh
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
19
|
Kurobe M, Sugihara T, Harada A, Kaji S, Uchida G, Kanamori D, Baba Y, Hiramatsu T, Ohashi S, Otsuka M. The Comparison of Postoperative Umbilical Port Site-Related Complications Between Transumbilical and Periumbilical Incision After Laparoscopic Surgery in Children. J Laparoendosc Adv Surg Tech A 2023; 33:807-813. [PMID: 37093029 DOI: 10.1089/lap.2022.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Introduction: No studies have directly compared postoperative umbilical port site (UPS)-related complications between transumbilical and periumbilical incisions (TUI and PUI) after laparoscopic surgery in children. Patients and Methods: We conducted a retrospective review of 324 children of ≤15 years of age who underwent laparoscopic repair (LR) for inguinal hernia, via either a TUI or PUI, between 2010 and 2020. UPS-related complications, such as wound infection and umbilical deformity, were compared between TUI and PUI. We also investigated the risk factors for the development of UPS-related complications after LR. Results: TUIs and PUIs were used for 228 and 96 children, respectively. The incidence rates of postoperative wound infection and umbilical deformity in the PUI group were higher in comparison to the TUI group; although not to a statistically significant extent (7.3% versus 5.3%, P = .451, 6.3% versus 4.8%, P = .593). One case of incisional hernia at the UPS was seen in the TUI group. In the univariate analysis, sex, age, weight for age Z-score, nutrition status, insertion and closure time, total operative time, American Society of Anesthesiologists score, blood loss, and comorbidities were not significantly associated with the development of UPS-related complications after LR. Conclusion: The incidence of UPS-related complications in TUI and PUI was not significantly different. Due to the low incidence of UPS-related complications, it was difficult to draw conclusions regarding contributing factors; however, meticulous care should be taken to avoid UPS-related complications when closing the UPS (Ethical approval No. 2019-24).
Collapse
Affiliation(s)
- Masashi Kurobe
- Department of Pediatric Surgery and Kawaguchi Municipal Medical Center, Kawaguchi, Japan
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Tetsuro Sugihara
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Atsushi Harada
- Department of Pediatric Surgery and Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Sayuri Kaji
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Goki Uchida
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Daisuke Kanamori
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Yuji Baba
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Tomomasa Hiramatsu
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Shinsuke Ohashi
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| |
Collapse
|
20
|
Pirson L, Absil G, Giet G, Lahrichi D, Nisolle M, Nikkels A. [Villar's nodule]. Rev Med Liege 2023; 78:420-422. [PMID: 37560953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Umbilical endometriosis is a rare manifestation, most often isolated, of endometriosis, accounting for 0,5-1 % of all cases. It can be primary or secondary following surgery. It usually presents as a solid, skin-colored, red or purple-black nodule, frequently associated with pain and/or perimenstrual bleeding. Because it has a potential for malignant transformation, the gold standard of treatment is surgical removal.
Collapse
Affiliation(s)
- Léna Pirson
- Service de Gynécologie, CHR Citadelle, Liège, Belgique
| | | | | | | | | | | |
Collapse
|
21
|
Zingaretti N, Intini SG, Albanese R, De Francesco F, Riccio M, Parodi PC. Umbilicus Necrosis During Mesh Repair of Rectus Diastasis for Abdominoplasty: Practical Tips for Prevention and Treatment. Aesthetic Plast Surg 2023; 47:28-31. [PMID: 35428917 DOI: 10.1007/s00266-022-02879-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Rectus muscles widened by pregnancy are handled in dramatically different ways in standard abdominoplasty and mesh abdominoplasty. Patients with significant abdominal wall laxity and/or umbilical hernia repair are treated with the use of retrorectus mesh placement. In these conditions the risk of damaging the blood supply to the umbilicus might be greater. Despite the fact that it is of no functional significance in adults, the umbilicus is a key esthetic landmark of the anterior abdominal wall. For both patients and surgeons alike, its absence, distortion, or misplacement after surgery can be distressing and can be a source of frequent patient complaint. Umbilical stalk necrosis represents an underreported yet important complication for patients following mesh abdominoplasty. We advance some recommendations for patients undergoing abdominoplasty with mesh repair of rectus diastasis and/or concomitant umbilical hernia mesh repair via the open approach. This information should help influence intraoperative decision-making to prevent the development of this undesirable complication.Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy.
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy.
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, 37135, Verona, Italy.
| | - Sergio Giuseppe Intini
- Department of General Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Francesco De Francesco
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Michele Riccio
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy
| |
Collapse
|
22
|
Aiyoshi T, Jimbo T, Gotoh C, Masumoto K. Transumbilical Reduced-port Laparoscopic Urachal Resection for Pediatric and Adolescent Patients. Surg Laparosc Endosc Percutan Tech 2023; 33:95-97. [PMID: 36730547 DOI: 10.1097/sle.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/21/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Port placement in laparoscopic urachal resection has not yet been standardized. We herein report an approach for transumbilical reduced-port laparoscopic urachal resection for pediatric and adolescent patients. METHODS We retrospectively reviewed the outcomes of pediatric and adolescent patients for urachal remnant treated with reduced-port laparoscopic urachal resection from 2016 to 2020 in our department. Regarding our surgical procedure, a skin incision was made around the umbilicus, and the urachus was dissected partially under direct vision. Two transumbilical 5 mm ports and a 3.5 mm port in the right lateral abdomen were placed. In the laparoscopic view, the urachus was dissected from the abdominal wall and resected at the bladder dome. The defect of the peritoneum was closed by suturing. RESULTS Sixteen patients underwent the procedure. The median patient age was 12.5 years old. Surgery was performed by trainee surgeons in all patients without intraoperative complications or conversion to open surgery. The median postoperative hospital stay was 2 days. CONCLUSIONS Our transumbilical reduced-port laparoscopic urachal resection technique has advantages in terms of safety, operability, and cosmetic appearance.
Collapse
Affiliation(s)
- Tsubasa Aiyoshi
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba,Tsukuba, Ibaraki, Japan
| | | | | | | |
Collapse
|
23
|
Dridi D, Buggio L, Donati A, Giola F, Lazzari C, Brambilla M, Chiaffarino F, Barbara G. Clinical Features and Management of Umbilical Endometriosis: A 30 Years' Monocentric Retrospective Study. Int J Environ Res Public Health 2022; 19:ijerph192416754. [PMID: 36554635 PMCID: PMC9779346 DOI: 10.3390/ijerph192416754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5-1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE. MATERIAL AND METHODS We retrospectively reviewed all cases of women diagnosed with UE in the period 1990-2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions. RESULTS A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received. CONCLUSIONS The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence.
Collapse
Affiliation(s)
- Dhouha Dridi
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Laura Buggio
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Agnese Donati
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Francesca Giola
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Caterina Lazzari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Service, Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Chiaffarino
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| |
Collapse
|
24
|
Dai X, Zhang Y, Wang F, Luo Y, Gong Y. Effects of Umbilical Preparation Before Trans-umbilical Laparo-endoscopic Single-site Surgery on Umbilical Wounds Healing: a Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2022; 32:632-636. [PMID: 36314980 DOI: 10.1097/sle.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The umbilicus is the only anatomic entrance and incision site for trans-umbilical laparoendoscopic single-site surgery (TU-LESS). Data on incisional surgical site infections (ISSI) and incision healing in TU-LESS are lacking. Therefore, we aimed to observe umbilical incision healing and possible hernia after TU-LESS and explore the efficacy of preoperative umbilicus preparation on ISSI. SUBJECTS AND METHODS Consecutive patients aged 18 to 65 years, who were scheduled to undergo TU-LESS at a teaching hospital between March 2020 and November 2021, were enrolled in this prospective study. All patients were randomized to the study group with preoperative umbilicus preparation 30 minutes before patients were sent to the operating room and to the control group without preparation. The umbilical dimple was disinfected twice using povidone-iodine in both groups before the skin incision. The primary outcome was ISSI within 30 days of surgery. Umbilical hernia at 3 months after surgery and perioperative data such as operation time, complications, and incision healing were recorded and compared. RESULTS A total of 400 patients were recruited for this study. TU-LESS was performed in all patients without major complications. ISSI occurred in 5 patients in the study group (2.5%) and 3 patients in the control group (1.5%), with no significant differences between both groups ( P =0.479). No umbilical hernia occurred in any patient during the 3 months follow-up. Six patients in the study group (3.1%) and 1 in the control group (0.5%) experienced excessive scarring, a relatively high incidence in the study group, though the difference was not statistically significant ( P =0.067). CONCLUSIONS TU-LESS-related umbilical hernias are rare with existing suturing methods. Umbilicus preparation before TU-LESS could not decrease ISSI; however, it increased the nursing workload, which should be avoided.
Collapse
Affiliation(s)
- Xuelin Dai
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | | | | | | |
Collapse
|
25
|
Quintanilla R, Galvez C, Nassau DE, Suarez MC, Babastro Y, Ransford A, Castellan M, Alam A, Gosalbez R. Simultaneous placement of fecal and urinary continent channel stomas in the umbilicus: Single-center experience. J Pediatr Urol 2022; 18:613.e1-613.e8. [PMID: 36109304 DOI: 10.1016/j.jpurol.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In patients with urinary continent channel (UCC) and Malone Antegrade Continent Enema (MACE) procedures, two separate abdominal stomas are needed. The umbilicus is a preferred site for single channel stomas given the ability to conceal the stoma. However, there are no studies describing outcomes of both stomas being created in the umbilicus. We aimed to describe our experience in patients who underwent UCC and MACE stomas both placed in the umbilicus. METHODS A retrospective review from 2009 to 2020 was performed in our institution for patients who underwent the creation of UCC and MACE stomas simultaneously in the umbilicus. The variation in the technique involves two V-skin shaped flaps in the umbilicus; the MACE and UCC stomas are delivered from both flaps and placed at the right and left side respectively. Patients with greater than 3 months of follow-up were included in the study. RESULTS There were 17 patients identified with the median age of 13.5 years and a median follow-up of 32.8 months. The mean BMI percentile was 89.5%. Monti technique and split appendix with cecal extension were utilized in 8 (47.1%) and 7 (41.2%) patients respectively and 13 (76.5%) patients required concurrent urological procedures. All channel-related complications occurred within a mean time of 15.7 months. Skin-level stenosis in the MACE occurred in 5 (29.4%) events, and all were successfully managed by placing an indwelling catheter for up to two weeks. There were 2 (11.8%) complications related to UCC, which required subfascial minor surgical revision. The rate of patients with symptomatic UTI decreased 35.3% postoperatively, and no new onset of UTI occurred in patients without a prior history of UTI. During follow-up, all patients remained dry between CIC, however one had occasional leakage related to delay in catheterization. Total fecal continence was achieved in 14 (82.3%) patients. Additionally, 3 (16.6%) patients experienced improvement in fecal continence with sporadic soiling episodes. COMMENTS Placement of UCC and MACE stomas in the umbilicus demonstrate a percentage of complication of 7/34 (20.6%) with only 2 patients requiring surgical intervention, comparable to the standard. UTI rate decreased in patients with a prior history of UTI. We believe the patients' perspective and degree of satisfaction will fully determine the benefits of this technique. CONCLUSIONS Simultaneous UCC and MACE stomas placed at the umbilicus showed good functional outcomes and similar complication rates to traditional approach where stomas were placed separately in the abdominal wall.
Collapse
Affiliation(s)
- Raquel Quintanilla
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA
| | - Cinthia Galvez
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Daniel E Nassau
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Maria Camila Suarez
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Yisel Babastro
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA
| | - Andrew Ransford
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Miguel Castellan
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Alireza Alam
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Rafael Gosalbez
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL 33155, USA; Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
| |
Collapse
|
26
|
Kc K, Shrestha M. Assessment of Modified Trans-umbilical Port Placement in Laparoscopy. J Nepal Health Res Counc 2022; 20:173-179. [PMID: 35945872 DOI: 10.33314/jnhrc.v20i01.3937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Primary port placement is a critical step in any laparoscopic procedure. Although the safety and efficacy of open versus closed technique has been much debated, no particular technique is considered as the best. Therefore, over the period of time different methods have been developed and applied in order to perform laparoscopy procedures, Midat hospital has been using a version of modified trans-umbilical open technique for primary port entry from 2 decades and this study is being carried out to evaluate the technique. METHODS Retrospective review was conducted. The patients who underwent laparoscopy surgery by modified trans-umbilical port placement at Midat hospital from June 2019- April 2020 were included in this study. RESULTS A total of 100 cases were studied. Cholelithiasis was the main indication of surgery. The mean time recorded to establish pneumoperitoneum was 3.4±1.3 minutes. The rate of umbilical swab culture growth was 1%, pre-peritoneal port placements was 2%. Post-operative primary port site infection rate was 4%. No intra-abdominal injury was noted during the entry of primary port and there was no port site hematoma or recorded hernia over the period of one year. CONCLUSION This technique of modified trans-umbilical primary port placement is one of the safest, fastest and easiest techniques to enter the peritoneal cavity.
Collapse
Affiliation(s)
- Kamana Kc
- Department of Gynecology and Obstrectics, MIDAT Hospital, Lagankhel
| | | |
Collapse
|
27
|
Savva D, Nittari G, Gibelli F, Vassiliou A. Survival of umbilicus on a superiorly based flap after fleur-de-lis abdominoplasty: A case report. Medicine (Baltimore) 2022; 101:e29115. [PMID: 35583525 PMCID: PMC9276170 DOI: 10.1097/md.0000000000029115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Massive weight loss patients have a midline excess of abdominal adipose and skin tissue that contributes to an increased abdominal girth. This excess of tissue in these patients is not resolved with traditional techniques of abdominoplasty and usually the fleur-de-lis abdominoplasty technique is employed. PATIENT CONCERNS A 22-year-old male patient came to our clinic after a massive weight loss of 170 kg, requesting an abdominoplasty for the excess adipose and skin tissue. DIAGNOSIS Massive weight loss patient, with excess of adipose and skin tissue in the midline abdominal area. INTERVENTIONS Fleur-de-lis abdominoplasty technique was employed for treatment of massive weight loss. OUTCOMES During the surgery, it was decided that the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament needed to be ligated, to remove more tissue for better aesthetic result. The umbilicus survived on the collateral blood supply from ligamentum teres and superior epigastric collaterals. CONCLUSION/LESSONS In this case report we review our experience treating a massive weight loss patient using a fleur-de-lis abdominoplasty technique without preserving the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament. We eventually relied on the collateral blood supply from ligamentum teres and superior epigastric collaterals, something that proved advantageous both in the survival of the umbilicus on the long run despite cutting off the main blood supply, and, the removal of further excess adipocutaneous tissue for a better aesthetic outcome.
Collapse
Affiliation(s)
- Demetris Savva
- Plastic Reconstructive and Aesthetic Surgery, Nicosia General Hospital, Nicosia, Cyprus
| | - Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Andreas Vassiliou
- Plastic Reconstructive and Aesthetic Surgery, Nicosia General Hospital, Nicosia, Cyprus
| |
Collapse
|
28
|
Graham KA, Livingston RJ. Ideal Male Umbilicus: An Observational Study of Surface Anatomy and Introduction to the SHAPE Classification. Aesthetic Plast Surg 2022; 46:2333-2341. [PMID: 35169914 PMCID: PMC9592660 DOI: 10.1007/s00266-022-02798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
Background The umbilicus is crucial to the aesthetic appearance of the abdomen. With abdominoplasty and umbilicoplasty, placement of the umbilicus is essential and often left at the surgeon’s discretion. This study aims to investigate the ideal male umbilical shape and location by examining photographs of top male models in 2019. Methods In this observational study, we examined 81 photographs of top male models to assess different ratios based on anatomical landmarks and umbilical appearance. Results The ratio of the distance from the xiphoid to the center of umbilicus (XU) and corresponding distance from center of umbilicus to abdominal crease (UC) had the most reliability (ratio XU/UC, with average measurement: 1.68 ± 0.38), which placed the male navel at a similar position but marginally below the average female umbilicus. Our findings revealed that an oval horizontal is the ideal umbilical shape in males, which differs from what is most aesthetically pleasing in females (oval vertical). In addition, we introduced the SHAPE (Shape, Hood, Adiposity, Protrusion & Position, External piercing) classification for navel appearance to better define the umbilicus and its direct management. Conclusions This study establishes that the ideal male umbilicus differs from that of females; it should be placed at the XU/UC ratio of 1.68 ± 0.38 and aim for a horizontal shape with hooding (SHAPE: H II). The SHAPE classification facilitates a logical stepwise approach for the surgeon to refashion the umbilicus. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-022-02798-7.
Collapse
Affiliation(s)
- Karissa A Graham
- Department of Plastic and Reconstructive Surgery, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, QLD, 4575, Australia.
| | - Ryan J Livingston
- Department of Plastic and Reconstructive Surgery, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, QLD, 4575, Australia
- Department of Medicine, University of Queensland, St. Lucia, QLD, Australia
- Department of Medicine, Griffith University, South Brisbane, QLD, Australia
| |
Collapse
|
29
|
Hurwitz DJ. Invited Discussion on: Simplified Technique for Creating an Umbilicus with Scarless Caudal Aspect and Superior Hooding. Aesthetic Plast Surg 2022; 46:1290-1292. [PMID: 35091772 DOI: 10.1007/s00266-021-02724-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Dennis J Hurwitz
- Hurwitz Center for Plastic Surgery, University of Pittsburgh Medical School, 3109 Forbes Avenue, Suite 500, Pittsburgh, Pennsylvania, 15213, USA.
| |
Collapse
|
30
|
Jamani NA, Nusee Z, Hamizah I. The bleeding umbilicus: An uncommon presentation of endometriosis. Med J Malaysia 2022; 77:132-134. [PMID: 35087015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Dysmenorrhea is a common presentation in women of reproductive age in primary care. It can negatively affect the quality of life of a woman and restrict her daily activities. Endometriosis is the most common diagnosis for secondary dysmenorrhea. However, cutaneous endometriosis is an uncommon presentation of endometriosis. It requires a thorough history, physical examination and histological findings for definitive diagnosis. This paper reports an interesting case of a 47- year-old woman with primary cutaneous umbilical endometriosis and its management. Her final diagnosis was primary umbilical endometriosis with Stage 3 endometriosis based on the patient's history, clinical and surgical findings. The patient was discharged well on day three of operation and has been well since then with no signs of recurrence.
Collapse
Affiliation(s)
- N A Jamani
- International Islamic University Malaysia, Kulliyyah of Medicine, Department of Family Medicine, Jalan Sultan Ahmad Shah, Kuantan Pahang, Malaysia.
| | - Z Nusee
- International Islamic University Malaysia, Kulliyyah of Medicine, Department of Obstetrics and Gynaecology, Jalan Sultan Ahmad Shah, Kuantan Pahang, Malaysia
| | - I Hamizah
- International Islamic University Malaysia, Kulliyyah of Medicine, Department of Obstetrics and Gynaecology, Jalan Sultan Ahmad Shah, Kuantan Pahang, Malaysia
| |
Collapse
|
31
|
Mernier T, Tong K, Ng ZY, Cetrulo CL, Lantieri L, Lellouch AG. Comment: "Umbilical Reconstruction Techniques: A Literature Review". Aesthetic Plast Surg 2021; 46:90-91. [PMID: 34331095 DOI: 10.1007/s00266-021-02498-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Thibaud Mernier
- Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | | - Zhi Yang Ng
- Plastic Surgery, School of Surgery, Oxford, UK
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laurent Lantieri
- Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Alexandre G Lellouch
- Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris, France.
| |
Collapse
|
32
|
Sisti A, Huayllani MT, Boczar D, Restrepo DJ, Cinotto G, Lu X, Cuomo R, Grimaldi L, Nisi G, Forte AJ. Umbilical Reconstruction Techniques: A Literature Review. Aesthetic Plast Surg 2021; 45:1078-1096. [PMID: 33098045 DOI: 10.1007/s00266-020-01989-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are many instances in which sacrificing the umbilicus is unavoidable. Umbilical reconstruction (umbiliconeoplasty) is an important surgical procedure to complete the abdomen's reconstruction and to give again a pleasant cosmetic appearance. OBJECTIVES To provide a complete overview of all surgical techniques for umbiliconeoplasty described in the literature. METHODS PubMed database was queried using 'umbilical and reconstruction', 'umbilicus and reconstruction', 'navel and reconstruction', 'umbiliconeoplasty', 'neo-omphaloplasty' or 'umbilicaneoplasty' to select the papers dealing with the reconstruction of the umbilicus. RESULTS Sixty different techniques for the reconstruction of the missing umbilicus were described in 77 papers. Local skin flaps and the purse-string suture technique were the most frequently described techniques. The Three flaps technique, the Four flaps technique and the 2 Lateral rectangular pedicle lateral flaps technique were the most popular local flap techniques. Indications ranged from congenital pediatric defects to reconstruction during abdominoplasty. CONCLUSIONS Several surgical techniques were described for umbilicus reconstruction. While there is not a universal algorithm for the choice of the technique, the surgeon may decide which technique to use based on other surgeons' experiences reports. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Andrea Sisti
- Division of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Maria T Huayllani
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - David J Restrepo
- University of Texas Health Science Center at San Antonio (UTHSCSA) General Surgery, San Antonio, TX, USA
| | - Gabriela Cinotto
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Roberto Cuomo
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
| |
Collapse
|
33
|
Bilger G, Nicolaï M, Perez M, Simon E. [Case report: Epigastric dermatofibroma reconstruction by reverse abdominoplasty with umbilic transposition]. ANN CHIR PLAST ESTH 2021; 66:261-267. [PMID: 33715869 DOI: 10.1016/j.anplas.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 11/18/2022]
Abstract
Dermatofibrosarcoma is the most common cutaneous sarcoma. Its surgical management is a technical challenge due to the high amount of substance loss. We explain a new technique of abdominal wall reconstruction by a reverse abdominoplasty with umbilical transposition. This new surgical technique allowed, in one time, the excision and the abdominal wall reconstruction. Functional and esthetic results are really satisfactory.
Collapse
Affiliation(s)
- G Bilger
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Nicolaï
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - M Perez
- Service de chirurgie générale d'urgence, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - E Simon
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| |
Collapse
|
34
|
Nikolopoulos M, Godfrey MAL, Chmielewska B, Maheshwari MK. Presentation of an open entry technique for laparoscopy through a congenital defect in the umbilical fascia. J Gynecol Obstet Hum Reprod 2020; 50:102045. [PMID: 33346161 DOI: 10.1016/j.jogoh.2020.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We present and describe a modification of the Hasson open entry technique to gain access to the abdominal cavity for laparoscopy in which a congenital defect in the umbilical fascia is identified for entry into the peritoneum and insertion of the primary port. METHODS A single centre, prospective, observational, pilot study has been conducted with no change in clinical practice. Data regarding the success of the technique, time to laparoscope insertion, complications and patient risk factors were collected and presented. RESULTS The team enrolled 114 patients that had the St Helier technique attempted for entry in the abdominal cavity. Entry was achieved for all patients. The technique had 82.5 % success rate while this reduced to 65 % in patients with previous laparoscopies. The mean time to insertion of the laparoscope was 220 s, and there was no significant difference in success with variation in BMI. We recorded no minor or significant intra-operative complications. The superficial wound infection rate was 2.6 % with no other postoperative complications identified at 6-week follow-up. CONCLUSIONS The presented technique is a safe and successful method of laparoscopic entry with a presumed shorter time until laparoscope insertion than other techniques used. The absence of complications could be attributed to the avoidance of sharp dissection of the umbilical fascia. The less invasive nature could reduce risks of hematoma, infection or hernia that are associated with the standard entry techniques used. Formal studies of long-term outcomes are required, as well as evaluating use in emergency and contaminated cases.
Collapse
Affiliation(s)
| | | | - Barbara Chmielewska
- St Helier Hospital, Epsom and St Helier University Hospitals & NHS Trust, UK
| | - Manish K Maheshwari
- St Helier Hospital, Epsom and St Helier University Hospitals & NHS Trust, UK
| |
Collapse
|
35
|
Takizawa K, Sakata J, Nagaro H, Yuza K, Toge K, Hirose Y, Ishikawa H, Sudo N, Miura K, Ichikawa H, Nagahashi M, Shimada Y, Kobayashi T, Ishikawa T, Wakai T. [A Case of Umbilical Metastasis from Pancreatic Cancer after Surgery]. Gan To Kagaku Ryoho 2020; 47:2409-2411. [PMID: 33468977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The patient was a 63-year-old woman with diagnosis of pancreatic cancer. Abdominal CT showed pancreatic head tumor and paraaortic lymph node metastasis. We performed chemotherapy with nab-paclitaxel plus gemcitabine. After 5 courses of chemotherapy, the tumor reduced in size. Pancreaticoduodenectomy followed by adjuvant chemotherapy with S-1 was performed. Fourteen months after surgery, umbilical metastasis(Sister Mary Joseph's nodule: SMJN)was found in the umbilicus near the abdominal incisional hernia. There was no evidence of metastasis except in the umbilicus, we performed the umbilical tumor resection and abdominal incisional hernia repair. Pathological diagnosis was pancreatic cancer metastasis. Although following chemotherapy, multiple skin metastases was found in the lower abdomen 3 months after umbilical resection. We performed skin metastases resection to relieve pain and symptoms of bleeding. But she died 29 months after the initial therapy(7 months after umbilical resection).
Collapse
Affiliation(s)
- Kazuyasu Takizawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
BACKGROUND Endometriosis is the presence of endometrial tissue outside the uterine cavity. The lesions are typically found in the pelvic cavity but can occur in other extrapelvic areas. Umbilical endometriosis, also known as Villar's node, is a rare disease comprising 0.5-1% of all extrapelvic disease. It commonly presents with cyclical pain and bleeding from an umbilical nodule. CASE SERIES We present a retrospective case series of five African patients with umbilical endometriosis diagnosed and treated between July 2015 and February 2019 at a tertiary health facility. The patients were aged between 31 and 47 years, and all presented with an umbilical swelling and pain. They had lesions with diameters ranging from 1.6 cm to 4 cm. The duration of symptoms ranged between 3 and 60 months. Their diagnoses were made on the basis of clinical presentation followed by surgical excision. In all the cases, diagnosis was confirmed by histopathology with no malignancy detected. CONCLUSION Umbilical endometriosis is a rare condition that should be considered as a differential diagnosis in women with umbilical lesions. Diagnosis is mostly clinical; most patients present with umbilical swelling, cyclical pain, and bleeding or discharge. Imaging has a limited role. Surgical excision is the treatment of choice with low risk of malignancy or recurrence.
Collapse
Affiliation(s)
- Dorothy Makena
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box, Nairobi, 30270-00100 Kenya
| | - Timona Obura
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box, Nairobi, 30270-00100 Kenya
| | - Steve Mutiso
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box, Nairobi, 30270-00100 Kenya
| | - Felix Oindi
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box, Nairobi, 30270-00100 Kenya
| |
Collapse
|
37
|
Chen QL, Chen K, Huang DY, Pan Y, Yan JF, Wang XF, Cai XY. Trans-umbilical single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty of inguinal hernia by self-made glove port. Medicine (Baltimore) 2020; 99:e21787. [PMID: 32846810 PMCID: PMC7447498 DOI: 10.1097/md.0000000000021787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.
Collapse
|
38
|
van der Sluijs PJ, Sleeboom C, Peetsold MG. [A neonate with soft tissue protruding through the umbilicus]. Ned Tijdschr Geneeskd 2020; 164:D4769. [PMID: 32779920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 6-week-old neonate presented with soft tissue protruding through the umbilicus due to a persisting ductus omphalo-entericus. This remnant was surgically removed the next day.
Collapse
Affiliation(s)
| | - Christien Sleeboom
- Amsterdam UMC, locatie AMC (Emma Kinderziekenhuis) en VUmc, afd. Kinderchirurgie, Amsterdam
| | - Marieke G Peetsold
- Alrijne ziekenhuis, afd. Kindergeneeskunde, Leiderdorp
- Contact: Marieke G. Peetsold
| |
Collapse
|
39
|
Belay RE, Maldonado J, Hu B. Excision and Reconstruction for Urachal Adenocarcinoma: A Case Report With an Emphasis on Cosmesis. Urology 2020; 139:198-200. [PMID: 32087210 DOI: 10.1016/j.urology.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We report a urachal adenocarcinoma case managed surgically with two incisions and an emphasis on cosmesis while maintaining oncologic principles. INTRODUCTION Depending upon the cancer, excision of the urachal remnant and umbilectomy may require abdominal wall reconstruction and potentially could leave the patient with an altered anterior abdominal wall. Restoring function and cosmesis after surgery can be very important to oncologic quality of life. Therefore, we present a patient with urachal adenocarcinoma who underwent open partial cystectomy, urachal ligament excision with umbilectomy, and neo-umbilicoplasty via two incisions. CONCLUSION This case demonstrates the feasibility of performing an oncologically-sound operation for urachal adenocarcinoma while maintaining an emphasis on cosmesis.
Collapse
Affiliation(s)
- Ruth E Belay
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | | | - Brian Hu
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| |
Collapse
|
40
|
|
41
|
McLean R, Richards S, Hulme K. Primary umbilical endometriosis. N Z Med J 2019; 132:95-99. [PMID: 31415504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
42
|
Shrestha S, Basnet BM, Thapa A. Paediatric Postoperative Intussusception. J Nepal Health Res Counc 2019; 17:258-260. [PMID: 31455945 DOI: 10.33314/jnhrc.v0i0.1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
Intussusception is one of the common causes of acute abdomen in early childhood, particularly in children younger than two years of age. The majority of cases in children are idiopathic. Pathologic lead points can be identified in only 25 percent of cases. Here. we present a case of 15 months female child with Ileoileal postoperative intussusception with an anastomotic margin as a lead point, following resection anastomosis done for patent vitello intestinal duct. Role of high clinical suspicion, investigations and judgement are highlighted in managing the case. Keywords: Anastomosis; ileoileal; postoperative intussusception; patent vitello-intestinal duct.
Collapse
Affiliation(s)
- Sundar Shrestha
- Department of General Surgery, NAMS, Bir Hospital, Kathmandu, Nepal
| | - Bal Mukunda Basnet
- Department of Pediatric Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anupama Thapa
- Department of Pediatric Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| |
Collapse
|
43
|
Guan Z, Liu J, Blazek K, Guan X. Robotic Single-Site Tubal Reanastomosis: The Robotic Factor. J Minim Invasive Gynecol 2018; 26:607. [PMID: 30176362 DOI: 10.1016/j.jmig.2018.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 08/25/2018] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To investigate the advantages of using robotic assistance in tubal reanastomosis surgery. DESIGN A narrated instructional video. SETTING University Hospital, Baylor College of Medicine, Houston, Texas (Canadian Task Force Classification III). PATIENT A 33-year-old woman, G2P2003, who regretted her prior tubal ligation; she continued to request for a tubal reversal with a desire to conceive in the near future. A single-site approach was decided on when she expressed concern for the cosmetic aftermath of multiport surgery. INTERVENTIONS Robotic single-site tubal reanastomosis. MEASUREMENTS AND MAIN RESULTS We performed robotic single-site tubal reanastomosis on the patient. We used the energy instruments of the monopolar hook and the bipolar slotted grasper. Entry was performed in the umbilicus, after which an abdominal survey was conducted to determine and locate the blocked fallopian tubes. A cold scissor, to avoid additional damage to the tubes, was used to resect the portion of the right blocked tube, and a neonatal feeding tube was inserted though both sections of the tube to ensure proper alignment during the repair. Additionally, a figure of eight suture was placed in the mesosalpinx to reduce the amount of tension during the tubal reanastomosis. We used 4 interrupted 5-0 PDS sutures, with 2 wristed needle drivers, to establish and precisely align the 2 sections of tube, first in the mucosal layer and then in the serosal layer, to achieve proper retention. Upon successful chromopertubation with methylene blue dye, the process was repeated on the left side. A successful tubal reanastomosis was completed and chromopertubation clearly demonstrated that the tubes were patent. Total operation time was approximately 100 minutes, resulting in a successful surgery. Estimated blood loss was only 20 mL. At 2 months after surgery a fluoroscopic hysterosalpingogram was conducted to verify the patency of the tubes. We concluded that both tubes were patent. CONCLUSIONS The single-site robotic approach provides a potent and valuable method for tubal reanastomosis, rendering difficult surgical techniques more accessible.
Collapse
Affiliation(s)
| | - Juan Liu
- Guangzhou Medical University, Guangzhou, China
| | - Kelly Blazek
- Minimally Invasive Gynecology Surgery, Baylor College of Medicine, Houston, Texas
| | - Xiaoming Guan
- Guangzhou Medical University, Guangzhou, China; Minimally Invasive Gynecology Surgery, Baylor College of Medicine, Houston, Texas..
| |
Collapse
|
44
|
Abstract
The traditional surgical approach for removing a symptomatic urachal remnant is via a lower midline laparotomy and infraumbilical incision or a laparoscopic approach with umbilicoplasty. We reviewed our experience with umbilicus-sparing laparoscopic urachal remnant excision in a single-center study and evaluated its efficacy versus open approach (OA). This study was a retrospective study. Between March 2012 and September 2016, 32 consecutive patients with symptomatic urachal remnants underwent the umbilicus-sparing laparoscopic approach (USLA) (n = 17) or OA (n = 15). The efficacy, recovery, and long-term outcomes were reviewed. Our Results showed that the clinical characteristics of the patients in each group, such as age, gender, body mass index (BMI), and disease type, had no significant differences (P > .05). No significant difference was found in the surgical procedure times (76.1 ± 15.4 vs 69.2 ± 13.9 minutes, P = .189) and intraoperative blood loss (29.4 ± 13.3 vs 32.2 ± 12.9 mL, P = .543) between the USLA groups and OA groups. However, the mean postoperative hospital stay (patients with bladder cuff excision: 4.1 ± 1.8 vs 6.1 ± 1.4 days, P = .040 and patients without bladder cuff excision: 1.8 ± 0.5 vs 3.6 ± 0.8 days, P < .001) and the time of full recovery (11.2 ± 1.9 vs 15.6 ± 3.1 days, P < .001), the USLA group were both significantly shorter than that of the OA group. No infected recurrence and malignant transformation had occurred at a mean follow-up of 32.4 ± 8.1 and 34.1 ± 8.8 months in USLA group and OA group, respectively. In conclusion, to minimize the morbidity of radical excision, umbilicus-sparing management of benign urachal remnants in adults is a safe and efficacious alternative with superior cosmetic outcomes, postoperative recovery compared with an OA or umbilicoplasty.
Collapse
|
45
|
Abstract
INTRODUCTION Liposuction is one of the most widely performed aesthetic surgeries. It is mainly used for the correction of deep and superficial fat accumulations and remodeling of the body contour. CASE PRESENTATION We present a rare case of unusual rubber foreign body found within the periumbilical area during the reconstruction of buried umbilicus after liposuction.A 61-year-old female had undergone a liposuction surgery 10 years ago. Last year, she experienced signs of inflammation around the periumbilical area. The patient was treated with antibiotics and daily dressing at a local clinic. However, her symptoms did not improve with treatment.After admission, we decided to reconstruct the umbilicus and explore the previous operative site. During reconstruction of umbilicus, we finally discovered a rubber foreign body in the periumbilical area and buried umbilicus. CONCLUSION Retained surgical foreign body can clinically manifest as acute reaction, such as an inflammatory response, infection, or abscess within days or weeks after the operation. Patients may complain of pain and discomfort, even months or years after the procedure.Our patient had suffered from delayed inflammation due to retained surgical foreign body after liposuction surgery. We emphasize the need for excellent communication within the surgical team to prevent the incidence of retained surgical bodies.
Collapse
Affiliation(s)
- Jong-Lim Kim
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
- Division, of Plastic surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Suk Choo Chang
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| |
Collapse
|
46
|
Abstract
BACKGROUND/INTRODUCTION Several reports have discussed the potential for reducing port access in laparoscopic sleeve gastrectomy (LSG); however, each approach had its innate setbacks. Aiming at improving the aesthetic outcome, we report a novel approach to the LSG where we place the trocars at the bikini line in what we described as bikini line sleeve gastrectomy (BLSG). METHODS The present work is a prospective, pilot study on the use of BLSG in patients, during the period between April and October 2016. Exclusion criteria included the following: large hiatal hernia, upper abdominal surgery, and xiphi-umbilical, xiphi-symphysis pubis, and xiphi-anterior superior iliac spine distances of > 25,36 and 33 cm, respectively. Four trocars were used: one at the umbilicus and three at the bikini line. All laparoscopic graspers were bariatric length instruments (43 cm). However, camera telescope, endoscopic stapler, and bipolar dissectors were standard length. RESULTS Twenty eight patients underwent BLSG. The mean age was 34.6 ± 3.7 years with a mean BMI of 42.46 kg/m2 ± 3. There were no major intra- or postoperative complications and no conversion to conventional port site placement. Patient's scar satisfaction was favorable. The mean postoperative BMI and weight at 6 m were 28.5 ± 1 kg/m2 and 79.8 kg ± 2, respectively. The mean percentage excess weight loss at 3, 6, and 12 months were 39.5 ± 4.6, 64.5 ± 5, and 69.8 ± 6%, respectively. CONCLUSION BLSG was found to be potentially safe, feasible, and effective with a favorable aesthetic outcome; it could possibly be offered to a select group of patients that are conscious about their scar appearance.
Collapse
Affiliation(s)
- Tamer N Abdelbaki
- General Surgery Department, Alexandria University Faculty of Medicine, 11 Hussein Nouh St, Shalalat, Bab Sharki, Alexandria, Egypt.
| |
Collapse
|
47
|
Siles Hinojosa A, Bragagnini Rodríguez P, González Ruiz Y, Fernández Atuan R, Álvarez García N, Elías Pollina J, Gracia Romero J. [Is there an ideal patient for transumbilical laparoscopic assisted appendectomy?]. Cir Pediatr 2017; 30:186-190. [PMID: 29266886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify the factors that lead to postoperative morbidity in acute appendicitis patients treated using a TULAA (Transumbilical laparoscopic assisted appendectomy) approach. MATERIAL AND METHODS Retrospective review of patients treated through a TULAA approach between 2007 and 2014. Data concerning the location of the appendix, need for conversion, appendiceal abscess or perforation, surgical time and other complications were collected. Student's T test and Chi-squared test were used for statistical analysis. RESULTS A total of 111 appendectomies underwent TULAA. The average operating time was 79 minutes (45-150). Nonperforated appendicitis was found in 90% of patients with 10% having perforated appendicitis or appendiceal abscess. In 35,13% of cases, additional trocars were used, usually when the appendix was in a retrocecal position (89,5%). When the appendix was found in a pelvic or ileal position, a need for extra trocars decreased to 25.9% (p< 0.05). The surgery was converted to open surgery in 6,3% of the cases. The appendix in a retrocecal position had a conversion rate of 20,8% compared to 2,3% of cases with an appendix in a pelvic location (p< 0.05). A total of 3,6% reported postoperative wound infection, possibly caused by perforation of the appendix during extraction (p< 0.05). All the perforated appendixes were considered complicated appendixes. CONCLUSIONS The retrocecal location of the appendix is associated with the need to install additional trocars or conversion to open surgery. The TULAA approach is ideal for patients with nonperforated acute appendicitis in a pelvic or ileal location.
Collapse
Affiliation(s)
- A Siles Hinojosa
- Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza
| | | | - Y González Ruiz
- Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza
| | - R Fernández Atuan
- Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza
| | - N Álvarez García
- Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza
| | - J Elías Pollina
- Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza
| | - J Gracia Romero
- Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza
| |
Collapse
|
48
|
Abstract
OBJECTIVE This article presents the first series of robotic single-port hysterectomy cases performed at a hospital in Brazil. METHODS From November 2014 to October 2016, 11 patients were indicated to undergo, and nine of them were submitted to single-port hysterectomy using da Vinci Single-Site® platform. However, in two patients, due to multiple previous abdominal surgeries, large uterine volume, and/or a uterus with no mobility, a pneumoperitoneum was performed with a Verres needle, and the pelvic cavity was assessed using a 5mm optics endoscope. In these cases, single-port surgery was not recommended; therefore, multiportal robotic access was chosen, and no intercurrent events were reported. Nine single-port cases were operated on by the same surgeon at Hospital Israelita Albert Einstein. Patient data analyzed included age, body mass index, previous surgeries, and clinical diagnosis. Surgical data included operative time, skin incision, report of intraoperative complications, need for conversion to laparotomy, need for transfer to intensive care unit, need for blood transfusion, inadvertent injury to other organs, length of hospital stay, and death. RESULTS All cases were completed with da Vinci Single-Site® system, with no intercurrent events. Four patients presented with adenomyosis as the surgical indication, two had uterine myoma, one endometrial cancer, one endometrial polyp, and one desquamative inflammatory vaginitis. The mean age of patients was 44 years (range, 40 to 54 years), and body mass index varied between 23.4 and 33.2kg/m2 (mean 26.4). No complications occurred in any of the cases, such as intestinal or bladder injury, bleeding, or the need for a second surgery. All nine procedures were completed with the robotic single-port access, and no patient required a blood transfusion. CONCLUSION Although this study merely presented an initial series of patients submitted to robotic single-port surgery, it demonstrated that the method is feasible and safe, suggesting the possible use of this technique in elective hysterectomy and other gynecological procedures in the future, as described in large reference centers of advanced surgery worldwide. Specifically, in gynecological practice, existing evidence on the use of robot-assisted, single-port surgery seems promising, and although it is not indicated in all cases, it should be considered as a surgical option. Nonetheless, further randomized and controlled clinical studies are necessary to establish the preeminence of robot-assisted, single-port surgery versus single-incision and conventional laparoscopy.
Collapse
Affiliation(s)
| | | | - Sérgio Podgaec
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
49
|
Kilpiö O, Härkki PSM, Mentula MJ, Jokela RM, Pakarinen PI. Transumbilical versus lateral transabdominal removal of benign adnexal masses in laparoscopic surgery-A randomized trial. Eur J Obstet Gynecol Reprod Biol 2017; 218:49-54. [PMID: 28950190 DOI: 10.1016/j.ejogrb.2017.08.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In laparoscopic adnexal surgery the conventional method of removing a mass from the abdominal cavity in Finland is through a 10-mm-wide lateral abdominal port. The larger the lateral trocar, the greater the risk of pain, complications and delayed recovery. Here, we assumed that adnexal mass removal through a 10-mm umbilical port together with 5-mm side trocars would decrease the postoperative need of analgesics when compared with removal through a 10-mm lateral abdominal port. STUDY DESIGN Women scheduled for laparoscopic surgery of a benign adnexal mass were invited to participate. The participants were randomized into two groups: removal via the transumbilical (TU) (n=21) or lateral transabdominal (TA) (n=21) route. General anesthesia and use of local anesthetics were standardized. The amount of postoperative opioid (oxycodone) and visual analog scale (VAS) scores for pain were the primary outcome measures. Secondary outcome measures were nausea/vomiting (VAS evaluation), time to discharge, peri- and postoperative complications, surgeons' opinions of the alternative methods and patients' satisfaction, evaluated via a questionnaire sent six months postoperatively. RESULTS There were no significant differences in the use of opioids or median pain-VAS scores between the groups during the first 24h postoperatively. However, in the TU group the amount of women with very low pain-VAS scores (0-1) during the whole 12-h follow-up time was significantly greater than in the TA group (4 vs. 0 women p=0.04). The amounts of nausea and vomiting, and median times to discharge were similar in both groups. There were no major complications. CONCLUSIONS Both transumbilical and transabdominal routes of abdominal mass removal during laparoscopy were feasible and safe. However, the transumbilical route resulted in more women with very low pain-VAS scores.
Collapse
Affiliation(s)
- Olga Kilpiö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi S M Härkki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit J Mentula
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ritva M Jokela
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi I Pakarinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| |
Collapse
|
50
|
Bertozzi M, Recchia N, Di Cara G, Riccioni S, Rinaldi VE, Esposito S, Appignani A. Ultrasonographic diagnosis and minimally invasive treatment of a patent urachus associated with a patent omphalomesenteric duct in a newborn: A case report. Medicine (Baltimore) 2017; 96:e7087. [PMID: 28746173 PMCID: PMC5627799 DOI: 10.1097/md.0000000000007087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONAL Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the vitelline duct. These anomalies are very rarely associated with one another. We describe a case of a newborn with a PU associated with a POMD, who was diagnosed by an abdominal ultrasound (US) and laparoscopy, and managed with a minimally invasive excision. PATIENT CONCERN A 28-day-old male neonate was referred to our hospital to investigate a delay in umbilical healing, with blood-mucinous material spillage for 3 weeks prior to the referral. The baby had no symptoms and was in good general health. DIAGNOSIS After a thorough cleaning of the umbilical stump, a clear granuloma with a suspected fistula was evident under the seat of the ligature of the stump. An abdominal US examination revealed the formation of a full communication, starting below the umbilical stump and developing along the anterior abdominal wall that connected with the bladder dome. The US also revealed a tubular formation containing air, which was compatible with POMD, in the deepest portion of the same umbilical stump. Considering these findings, the rare diagnosis of a PU associated with a POMD duct was suspected. INTERVENTIONS The child was then hospitalized for an elective laparoscopy that confirmed the US picture, and a minimally invasive excision was performed. OUTCOME The postoperative course was favorable and uneventful. LESSONS Our case underlines the importance of evaluating all persisting umbilical lesions without delay when conventional pharmacological therapies fail. Using a US as the first approach is valuable and should be supported by laparoscopy to confirm the diagnosis; a minimally invasive excision of the remnants appears to be an effective therapeutic approach.
Collapse
Affiliation(s)
| | | | - Giuseppe Di Cara
- Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | | | | | - Susanna Esposito
- Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | | |
Collapse
|