A Modified Umbilical Incision for Laparotomy in Newborns and Small Infants

Abstract

Purpose: A modified upper abdominal incision through the umbilicus has previously been described by one of the authors (Salakos) for performing pyloromyotomy in hypertrophic pyloric stenosis. The advantages were easier access to the peritoneal cavity, and better cosmetic results compared with epigastric transverse or midline incisions. Methods: Using the same umbilical incision, a wider incision in the aponeurotic fascia following the skin incision lines has been added, thus allowing better access to the abdominal contents, and enabling an easier exteriorization of the bowel. Results: This surgical approach was used in 23 babies- mean gestational age 34 ± 5.28 weeks and mean birth body weight 1980 ± 1048g. The mean age at the time of surgery was 12 ± 30 days. Indications for surgery included: necrotizing enterocolitis or its complications (n=9), small bowel perforation (n=3), malrotation (n=3), meconial ileum (n=2), intestinal dysmotility due to prematurity (n=2), intestinal atresia (n=2), gastric perforation (n=1), and omphalomesenteric duct remnants causing obstruction (n=1). Six patients were left with an ileostomy. Wound infection occurred in 3 cases and there was no dehiscence. Conclusions: We have extended the use of a modified open umbilical access to manage a broader range of surgical conditions in neonates and infants achieving good exposure and cosmetic appearance.