BACKGROUND
Techniques used to repair congenital umbilical hernias, that do not involve raising complex skin flaps, often result in the loss of the umbilical depression.1–3 This report describes a straightforward method for paediatric umbilical hernioplasty that we feel enables a good repair and achieves an acceptable cosmetic outcome.
TECHNIQUE
The umbilical skin is lifted and a circular incision is made leaving approximately 0.5 cm of skin for the construction of the neo-umbilicus. The excess skin is discarded and the defect in the linea alba is identified (Fig. 1). The hernial sac is reduced or excised and the defect is closed using four interrupted 3–0 absorbable sutures, with care to leave the lateral two sutures long. An anchor suture is then placed through the subcuticular superior part of the wound. The long lateral sutures are used to lift the fascia away from the underlying peritoneum enabling the anchor suture to be passed safely across the closed defect (Fig. 2) and finally through the subcuticular inferior part of the wound. A purse string suture is then used to close the skin defect (Fig. 3). The anchor suture is finally tied creating an umbilical depression (Fig. 4).
Figure 1.
Discarding the excess skin enables clear access to the hernial defect.
Figure 2.
The anchor suture traverses the closed defect.
Figure 3.
The purse string is drawn before the anchor suture is tied.
Figure 4.
Immediate postoperative result.
DISCUSSION
Over a period of 3 years, the senior author has repaired 20 congenital umbilical hernias using this technique. There have been no postoperative complications or recurrences and both patients as well as parents have been pleased with the aesthetic results (Fig. 5).
Figure 5.
Three-month postoperative result.
References
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