Original article

Umbilicoplasty for giant umbilical hernia: a new technique

Umbilicoplastia em hrnia umbilical gigante: uma nova tcnica
Maurcio Macedo1, Karine Furtado Meyer2, Olga Maria Garcia Ferreira3, Lina Wang4, Fabiana Imagawa5

aBStract
Objective: We report the results of a simple technique for umbilicoplasty recently used in patients with umbilical hernia and large umbilical protrusion. Methods: Between December 2005 and July 2006, ten children with umbilical hernia and large umbilical protrusion were treated with the technique described. Results: There were no postoperative complications, and the new technique produces acceptable aesthetic results. conclusions: The new technique for umbilicoplasty presents good solution for reconstruction of the protruding umbilical skin. Keywords: Hernia, umbilical/surgery; Surgical procedures, operative/ methods

close spontaneously and do not require surgical treatment(1). Umbilicoplasty is necessary for giant protruding hernias with excess skin(1). Many techniques were described(1-6), but the aesthetic results are often unsatisfactory. This new technical option was developed with the objective of reconstructing an umbilical scar with an acceptable aesthetic result.

reSUMO
Objetivo: Descrever os resultados obtidos com uma tcnica criada recentemente e utilizada para pacientes com hrnia umbilical com pele redundante. Mtodos: Entre dezembro de 2005 e julho de 2006, dez crianas com hrnia umbilical gigante foram tratadas pela tcnica cirrgica descrita no presente trabalho. resultados: No houve complicaes ps-operatrias, e essa nova tcnica produziu resultado cosmtico satisfatrio. concluses: A nova tcnica para umbilicoplastia apresenta boa soluo para a reconstruo umbilical em redundncia de pele local. Descritores: Hrnia umbilical/cirurgia; Procedimentos cirrgicos operatrios/mtodos

MetHODS Between December 2005 and July 2006, ten children with giant protruding umbilical hernias with excess skin (Figures 1 and 2) underwent umbilicoplasty according to the technique described below. The age range was two months to ten years.

intrODUctiOn Umbilical hernia is a frequent clinical condition in childhood and often observed in the daily practice of pediatric surgeons. Small aponeurotic defects usually

Figure 1. Initial aspect of umbilical hernia with excess skin

Study carried out at the Hospital Infantil Darcy Vargas So Paulo (SP), Brazil.
1 2 3 4 5

Head of the Department of Surgery at Hospital Infantil Darcy Vargas So Paulo (SP), Brazil. PhD, Member of the Pediatric Surgery team at Hospital Israelita Albert Einstein HIAE, So Paulo (SP), Brazil. Member of the Pediatric Surgery team at Hospital Israelita Albert Einstein HIAE, So Paulo (SP), Brazil. Member of the Pediatric Surgery team at Hospital Israelita Albert Einstein HIAE, So Paulo (SP), Brazil. Member of the Pediatric Surgery team at Hospital Israelita Albert Einstein HIAE, So Paulo (SP), Brazil.

Corresponding author: Maurcio Macedo Rua Comandante Gracia Dvila, 37 Morumbi CEP 05654-040 So Paulo (SP), Brasil Tel.: 11 3772 4594 e-mail: mmmacedo@uol.com.br Received on Feb 2, 2007 Accepted on Jan 14, 2008

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Macedo M, Meyer KF, Ferreira OMG, Wang L, Imagawa F

Figure 4. Skin incision

Figure 2. Initial aspect giant umbilical hernia

Every patient was treated under general anesthesia, with endotracheal tube, and received 50 mg/kg first generation cephalosporin on anesthetic induction.

Surgical technique 1. Four skin sites were marked (Figure 3):

Figure 5. Dissecting the hernial sac

Figure 3. Landmarking

a) upper: apex of skin protrusion; b) lower: place of the skin fold between the navel and the abdominal wall; c) lateral: 0.5 to 1 cm medial to the skin fold between the navel and abdominal wall. 2. linking the four landmarks in a diamond shape (with convex lines in the upper part, and concave ones in the lower part);
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3. skin incision in the demarcated area (Figure 4); 4. dissection of the hernial sac, releasing it from the aponeurosis, transfixing ligation and ressecting the base (Figure 5); 5. dissection and transverse repair of the aponeurotic defect; 6. the upper lines of the diamond are drawn together with continuous, absorbable, intradermal suture. This is the new umbilical scar which is invaginated and fixed to the aponeurosis (Figure 6); 7. intradermal longitudinal suture of the lower lines of the diamond (Figure 7); 8. occlusive and compressive dressing with gauze and plastic adhesive drapes.

reSUltS The aesthetic results were satisfactory in all patients (Figure 8). There were no postoperative complications. This technique was easy to learn and to perform.

Umbilicoplasty for giant umbilical hernia: a new technique

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Figure 6. Intradermal suture of the upper lines of the diamond, making the new umbilical scar that is fixated to the aponeurosis

Figure 7. Longitudinal suture of the lower lines of the diamond

Limitations of this study: very small series and short follow-up to observe a long-term cosmetic result. Further studies are necessary so that this procedure is established as a definitive solution for the problem of large protruding hernias with excess skin in children.

cOnclUSiOnS This new technique provides a good solution for reconstruction of the protruding umbilical skin reFerenceS
Figure 8. Final aspect

1.

DiScUSSiOn The number of techniques described in the medical literature for umbilicoplasty in cases of giant umbilical hernias demonstrates that there is no ideal surgical approach for such cases(1-6). The difficulty does not lie in the closure of the aponeurosis but in removing the excess skin leading to a satisfactory aesthetic effect. The technique described proved to be a simple method with excellent aesthetic results and no complications.

Ikeda H, Yamamoto H, Fujino J, Kisaki Y, Uchida H, Ishimaru Y, et al. Umbilicoplasty for large protuding umbilicus accompanying umbilical hernia: a simple and effective technique. Pediatr Surg Int. 2004;20(2):105-7. Cone JB, Golladay ES. Purse-string skin closure of umbilical hernia repair. J Pediatr Surg. 1983;18(3):297. Reyna TM, Hollis HW, Smith SB. Surgical management of proboscoid hernia. J Pediatr Surg. 1987;22(10):911-2. Sugawara Y, Hirabayashi S, Asato H, Yoshimura K. Reconstruction of the umbilicus using a single triangular flap. Ann Plastic Surg. 1995;34(1):78-80. Blanchard H, St-Vil D, Carceller A, Bensoussan AL, Di Lorenzo M. Repair of the huge umbilical hernia in black children. J Pediatr Surg. 2000;35(5):696-8. Kajikawa A, Ueda K, Suzuki Y, Ohkouchi M. A new umbilicoplasty for children: creating a longitudinal deep umbilical depression. Br J Plast Surg. 2004;57(8):741-8.

2. 3. 4. 5. 6.

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