Umbilical Complications Research Articles

The Preservation of Umbilical Blood Supply in Combined Ventral Hernia Repair and Abdominoplasty: A Narrative Review.

Combined ventral hernia repair and abdominoplasty treat risk factors such as high body mass index and weak abdominal musculature, providing excellent intraoperative exposure and improved patient outcomes. Unfortunately, a combination of traditional procedures is unfeasible as the umbilical blood supply would be compromised, leading to increased umbilical necrosis risk. This narrative review aimed to identify new techniques and solidify evidence in preserving umbilical blood supply and associated level of evidence. Two authors conducted a thorough literature search on PubMed, Scopus and Cochrane CENTRAL databases from January 1901 to July 2023, adhering to the methodologies of the preferred reporting items for systematic reviews and meta-analyses. Studies were reviewed for their surgical technique and quality of evidence. The primary outcomes of interest consisted of umbilical complications of this combined procedure. Six techniques were identified that included laparoscopic, pre-rectus, unilateral, distal bilateral, proximal bilateral, and inferior midline approaches. All techniques demonstrated as viable options in preserving umbilical blood supply as reported complications were few, minor, and compounded by risk factors. However, all included techniques were limited to low-to-moderate-quality evidence. Despite the lack of high-quality evidence, all techniques remain viable options for combined ventral hernia repair and abdominoplasty. Large-scale high-quality RCTs are required to compare the effectiveness of various approaches with additional outcomes of hernia recurrence rates, intraoperative time, and patient- and surgeon-reported satisfaction. 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 .

Abdominal donor-site complications following autologous breast reconstruction: A multi-institutional multisurgeon study

BackgroundThe deep inferior epigastric perforator (DIEP) free flap is the gold standard procedure for autologous breast reconstruction. Although breast-related complications have been well described, donor-site complications and contributing patient risk factors are poorly understood. MethodsWe examined a multi-institutional, prospectively maintained database of patients undergoing DIEP free flap breast reconstruction between 2015 and 2020. We evaluated patient demographics, operative details, and abdominal donor-site complications. Logistic regression modeling was used to predict donor-site outcomes based on patient characteristics. ResultsA total of 661 patients were identified who underwent DIEP free flap breast reconstruction across multiple institutions. Using logistic regression modeling, we found that body mass index (BMI) was an independent risk factor for umbilical complications (odds ratio [OR] 1.11, confidence interval [CI] 1.04–1.18, p = 0.001), seroma (OR 1.07, CI 1.01–1.13, p = 0.003), wound dehiscence (OR 1.10, CI 1.06–1.15, p = 0.001), and surgical site infection (OR 1.10, CI 1.05–1.15, p = 0.001) following DIEP free flap breast reconstruction. Further, immediate reconstruction decreases the risk of abdominal bulge formation (OR 0.22, CI 0.108–0.429, p = 0.001). Perforator selection was not associated with abdominal morbidity in our study population. ConclusionsHigher BMI is associated with increased abdominal donor-site complications following DIEP free flap breast reconstruction. Efforts to lower preoperative BMI may help decrease donor-site complications.

Umbilical Complications That Require Surgical Intervention after Gynecologic Laparoscopic Surgery.

In laparoscopic surgery, the trocar is often inserted through the umbilicus because of the ease of insertion and inconspicuous postoperative scar formation. However, postoperative complications that require plastic surgical intervention may occur to the umbilicus. We reviewed 14 patients who received plastic surgery for umbilical issues following gynecologic laparoscopic surgery in our department from January 2015 to September 2021. Most complications requiring umbilical surgery post gynecologic laparoscopic surgery include local infections, scar contractures, ectopic endometriosis, and umbilical necrosis. Mass resection and umbilical formation procedures were performed under general or local anesthesia. After a follow-up period of 6 months following surgery, no incidences of tumor development or recurrence of infection were seen, and the hypertrophic scar at the wound site gradually healed after the complete removal of the tumor and adequate suturing. Pathologically, 90% of the cases with keloid-like collagen disorder had concomitant inflammatory diseases such as epidermal cysts and abscesses. The majority of umbilical complications associated with laparoscopic surgery were predicted to be due to implantation of epithelial and tumor components during laparoscopic surgery and delayed postoperative inflammation. Therefore, it is necessary to educate surgeons about general measures of local infection control and careful surgical manipulation to prevent umbilical problems associated with laparoscopic surgery.

Umbilical Complications following DIEP Flap Breast Reconstruction: Demonstrating the Added Benefit of Preoperative Imaging.

Despite the umbilicus being an essential aesthetic unit, current literature on umbilical outcomes following abdominally based breast reconstruction is limited. In this study, the authors aim to elucidate the incidence and predictors of umbilical complications following deep inferior epigastric perforator (DIEP) flaps, with a particular emphasis on past abdominal surgery by type and measures that can be obtained easily from preoperative imaging. An institutional review board-approved retrospective review of 258 patients who underwent DIEP flap reconstruction from 2011 through 2020 was performed. Patient demographics, preoperative laboratory studies, and intraoperative factors were appraised. Preoperative computed tomographic angiography or magnetic resonance angiography was used to measure umbilical stalk height (SH), abdominal wall thickness (AWT), and total fascial diastasis. Patients with and without perfusion-related umbilical complications were compared. Forty patients (15.5%) developed umbilical complications, including 20 patients with epidermolysis or scab, 12 with dehiscence, and 14 with partial necrosis. Patients with complications had a significantly higher rate of hypertension, previous abdominal midline incision, more lateral perforators per flap, longer umbilical stalk, and larger SH/AWT ratio ( P < 0.05). Logistic regression revealed that SH ( P = 0.006) and SH/AWT ratio ( P < 0.001) were the only significant predictors, with the latter having a greater area under the receiver operating characteristic curve (area under the curve, 0.79; P < 0.001). Radiographic measurements of umbilical SH and SH/AWT ratio reliably predict the occurrence of umbilical complications, with the ratio having a more robust predictive ability. The authors propose the use of routine preoperative imaging to identify high-risk patients who may benefit from prophylactic measures. Risk, III.

An Algorithmic Approach to Umbilical Inset during DIEP Flap Reconstruction.

An aesthetically pleasing umbilicus is a critical component to the overall cosmesis and resultant patient satisfaction after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Because of variables in body habitus, comorbidities, and technical aspects of the procedure, patients undergoing DIEP flap breast reconstruction are at a higher risk of umbilical complications and poor aesthetic appearance of the neoumbilicus compared with those undergoing cosmetic abdominoplasty. To minimize these potential problems and maximize the overall aesthetic appearance of the abdomen, the authors propose an algorithmic approach to umbilical inset after DIEP flap harvest that takes into account several critical factors: the thickness of the subcutaneous tissue of the abdominal flap, the length of the umbilical stalk, and the depth of the umbilical bowl. This simple algorithmic approach is a useful tool that will assist surgeons in minimizing umbilical complications and delivering a superior cosmetic appearance to the abdominal donor site in DIEP flap reconstruction.

Midline epigastric scars can be associated with higher umbilical complications following DIEP flap harvest

Umbilical complications can be relatively common after breast reconstruction with deep inferior epigastric perforator (DIEP) flaps. The medial umbilical ligaments and the ligamentum teres hepatis can be the sole blood supply to the umbilicus after a DIEP flap harvest. Prior incisions along the epigastric midline may disrupt the ligamentum teres hepatis. In this retrospective study, we assess the influence of previous midline epigastric scars on umbilical complications after DIEP flap harvest. All patients who underwent breast reconstruction with DIEP flaps were identified at an academic institution over six years. Relevant sociodemographic and clinicopathologic factors were reviewed in the electronic medical records. Univariate and multivariate analyses were performed to determine the role of clinical variables to predict the chance of umbilical complications. A total of 243 patients met inclusion criteria, with 39 patients (16%) having prior surgery utilizing midline epigastric incisions. Twenty-one patients had umbilical complications. No significant difference in patient characteristics was found between patients with and without prior midline epigastric scars. Patients with a history of previous midline epigastric scars had a higher rate of umbilical complications (20.5% vs. 6.4%, p < 0.01). Bilateral medial row perforator-based DIEP flap harvest was also related to a higher rate of umbilical complications (18.4% vs. 6.2% p < 0.01). Previous midline epigastric scars are associated with higher rates of umbilical complications after DIEP flap harvest. Bilateral medial row perforator-based DIEP flap harvest exacerbates the rate of umbilical complications and should be avoided in patients with prior midline epigastric incision whenever possible.

Assessment of the effect of size of the umbilical ring on the risk of umbilical hernia complication in children

Introduction and aim. Assessment of risk of complications in umbilical hernia is important. The aim of this study was to evaluate the effect of size of the umbilical ring on the risk of complication occurring in umbilical hernia. Material and methods. This was a prospective study of children who had umbilical hernia repair for symptomatic umbilical hernia. Using Vernier caliper, the umbilical ring diameter (URD) was measured at surgery and the patients were divided into 2 groups. Group A had URD of less than of 15 millimeter (mm) and group B patients had URD of 15 mm and above. The 2 groups were compared. Results. Thirty two cases were evaluated. Their mean age was 42 months. All the patients had umbilical pain. Twenty six (81.3%) patients had URD of less than 15 mm (group A) whereas 6 (18.7%) patients had URD of greater or equal to 15 mm (group B). Group A patients had a mean URD of 12.1±3.4 mm whereas group B patients had a mean URD of 30.5±5.0 mm (p=0.001). Conclusion. Children who have URD of less than 15 mm are at a higher risk of developing umbilical hernia complications.

Leukocyte Adhesion Deficiency-I (LAD-I): A Comprehensive Review of Published Cases

LAD-I is a rare disorder of leukocyte adhesion, resulting from ITGB2 gene mutations encoding for the Beta-2 Integrin component CD18. CD18 deficiencies prevent integrin dimerization and endothelial leukocyte adhesion, essential for extravasation and antimicrobial activity. LAD-I is characterized by delayed separation,of the umbilical cord, omphalitis, poor wound healing and leukocytosis. Severe LAD-I (<2% of normal neutrophil [PMN] CD18 levels) is characterized by recurrent serious infections and early mortality unless treated by allogeneic haematopoietic stem cell transplant (HSCT). Mortality for severe LAD-I was reported as 75% by age 2 in an initial 1988 multicenter retrospective study. Moderate LAD-I (2-30% of PMN CD18 levels) is more indolent; although most pts survive childhood with recurrent skin and mucosal surface infections, mortality by age 40 can exceed 50%.Reports regarding LAD-I have been published in recent decades but no recent comprehensive prognostic assessments are available. We sought an updated understanding of severe LAD-I with emphasis on prognosis in the absence of HSCT, HSCT outcomes and association of CD18 expression with clinical features. We created a database of all published LAD-I cases via Pubmed searches and review of available references.Three hundred thirty LAD-I cases were reported between 1975-2017 in 111 publications (89 case-reports; largest series n=36). The nations reporting the most cases were Iran (n=64), USA (n=52), and India (n=45); the highest number of publications were from US centers (26). 113 pts were considered to have severe LAD-I, 63 moderate and 154 were not classified. PMN CD18 expression levels was reported for 270 cases and was <2% in 138 patients (51%) and ≥2% in 132 pts. Four pts with CD18 >2% were considered to have severe LAD-I (CD18% range 2.4 - 17.3). Gender was noted for 289 pts; 153 (53%) were male. Age at presentation was reported for 152 cases. For 65 pts with CD18<2%, median presentation was age 1 m (range 0.03-18m); for 64 pts with CD18 ≥2%, median presentation was age 6m (range 0.03-192m).We sought to understand whether prognosis for severe LAD-I in the absence of HSCT is similar to the initially-reported 25% survival to age 2. There were 59 severe LAD-I cases (per investigator assessment or CD18 <2%) for whom survival to 2 years was reported, 38 of whom died prior to age 2 (64% mortality). Mortality was similar for the subset of 43 cases reported since 2000 (58%, 25 deaths). Early mortality was substantially lower in patients with CD18 ≥2% and the majority of pts with CD18 >4% survived to adulthood. Outcomes for 119 pts who received HSCT were consistent with recent series; phenotypic correction was reported in 85% of pts with HLA-matched sibling donors. Mortality was 15% overall (8% for HLA-matched sibling recipients). The 27 pts receiving haploidentical HSCT had frequent graft failure (33%) with 16 (59%) receiving ≥1 subsequent HSCT.Infection details and CD18% were available for 159 (48%) cases. The most frequent infections in pts with CD18 <2% were respiratory tract (39%), sepsis (28%) and otitis media (27%) and for pts with CD18 ≥2% they were periodontal (51%), otitis media (35%) and sepsis (25%). Perianal skin infections and necrotic skin ulcers were noted in >10%. Umbilical complications were more frequent in severe LAD-I (94 of 112 pts with CD18<2% [84%] and 49 of 83 with CD18 ≥2% [59%; p = 0.0001]). For severe LAD-I pts with ≥2 years of follow-up (or death prior to 2y), there was correlation between absence of umbilical complications and survival to 24 m (p < 0.001). WBCs were reported in 149 cases (median 45 x 109/L; range 10 - 150 x 109/L) (normal range 4.5 to 11 × 109/L).There were limited correlations between CD18 expression and WBC (r < 0.1) and between CD18 and CD11 expression (r < 0.5).Severe LAD-I remains a life-threatening condition with limited 2-year survival in the absence of allogeneic HSCT. Umbilical complications and granulocytosis occur in nearly all pts. Respiratory tract, ear, sepsis, oral and skin infections are common. HSCT is potentially curative; transplant-mortality and other complications are frequent, especially in haploidentical transplants. Rapid identification of pts with potential LAD-I (unusual or severe infections in infancy, granulocytosis and umbilical complications) is essential to enable referral to centers with disease expertise. DisclosuresThrasher:4bio Ventures Management Ltd: Other: Advisory Board; Orchard Therapeutics: Consultancy; Rocket Pharmaceuticals Ltd: Consultancy; Torus Therapeutics, Inc: Other: Advisory Board. Kohn:BioMarin Pharmaceutical: Research Funding; Orchard Therapeutics Ltd.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Biogen IDEC: Research Funding.

Application of Micro-single-hole Laparoscopy Combined with Hysteroscopy in Diagnosis and Treatment of Complex Uterine Cavity Diseases

Object: To investigate the feasibility and safety of hysteroscopic surgery for diagnosis and treatment of complex uterine cavity diseases under the monitor of 5mm-mini-incision micro-single-hole laparoscopic surgery. Methods: A retrospective analysis of 15 patients with complex uterine cavity diseases undergoing hysteroscopic surgery underwent 5mm-mini-incision micro-single-hole laparoscopic surgery was performed in the Department of Obstetrics and Gynecology, the Affiliated Changzhou NO. 2 People’s Hospital of Nanjing Medical University from April 2018 to March 2019. Among them, 8 cases were intrauterine adhesion, 3 cases were uterine submucosal fibroid, 3 cases were uterine septum, 1 case was post-cesarean scar pregnancy, ages from 23 to 45 years old, BMI 17.65-25.48kg/m2. The operation was performed through a 5mm-mini-incision from the midline of the umbilicus. The 40/50 small abdominal retractor was used to expand the incision approach. A 3-mm small lens (A cystoscope or a hysteroscope was used for some patients) was placed into the single-port approach to perform the laparoscopic surgery; hysteroscopic surgery was performed by hysteroscopy through the cervix. Results: All the 15 patients were successfully operated. One patient with severe intrauterine adhesion had uterine perforation during operation. The uterus was repaired and sutured under micro-single-hole laparoscopy perfectly. No other channels were added during operation, and no laparotomy was performed. The operation time was 20-125 min, in which the surgical path establishment time was 5-10 min, the umbilical reconstruction time was 3-5 min; the intraoperative blood loss was 5-10 ml, and the postoperative hospital stay was 3-7 days. The postoperative umbilical incision healed well, and there was no surgical scar in the abdomen after surgery. No postoperative umbilical hernia and other serious complications occurred. Conclusion: Under the premise of mature umbilical single-port laparoscopy, it is safe and effective to use 5mm-mini-incision micro-single-hole laparoscopic surgery as a monitor during hysteroscopy for the diagnosis and treatment of complex uterine cavity diseases. It will achieve a better cosmetic result than traditional laparoscopy.

Metal-on-metal (MoM) hip implants and pregnancy: are MoM implants good for mom?—a systematic review

Metal-on-metal (MoM) bearing surfaces were historically used for young patients undergoing total hip arthroplasty, and remain commonplace in modern hip resurfacing. A substantial number of female patients with MoM bearings subsequently gave birth following implantation of the bearings before a full understanding of metal ions exposure in these patients was established. In theory, it has been postulated that metal ions released from such implants may cross the placental barrier and cause harm to the fetus. In light of this potential risk, recommendations against the use of MoM components in women of child-bearing age have been advocated. The purpose of this systematic review was to evaluate: (I) the MoM bearing types and ion levels found; (II) the concentrations of metals in maternal circulation and the umbilical cord; and (III) the presence of abnormalities in the fetus or delivered child. A comprehensive literature review was conducted of studies published between January 1st, 1975 and April 1st, 2019 using specific keywords. We defined the inclusion criteria for qualifying studies for this review as follows: (I) studies that reported on the women who experienced pregnancy and who had a MoM hip implant; (II) studies that reported on maternal metal ions blood and umbilical cord levels; and (III) studies that reported on the occurrence of fetal complications. Data on cobalt and chromium ion levels in the maternal blood and umbilical cord blood, as well as the presence of adverse effects in the infant were collected. Age at parturition and time from MoM implant to parturition were also collected. A total of six studies were included in the final analysis that reported on a total of 21 females and 21 infants born. The mean age at parturition was 31 years (range, 24 to 41 years), and the mean time from MoM implantation to parturition was 47 months (range, 11 to 119 months). Maternal blood cobalt levels were found as a weighted average of 34.09 ug/L (0.425 to 138 ug/L), while umbilical cord blood cobalt levels were found to be 22.61 ug/L (0.52 to 51.11 ug/L). Cobalt levels were reduced by an average of 34% between maternal and umbilical cord blood. Maternal cord blood chromium levels were found as a weighted average of 18.18 ug/L (0.225 to 75 ug/L), while umbilical cord chromium levels were found to be 3.96 ug/L (0.14 to 11.96 ug/L). Chromium levels were reduced by an average of 78% between maternal and umbilical cord blood. No cobalt or chromium was detected in the umbilical cord blood of three patients. Out of the 21 infants born to women with MoM implants, 20 were born healthy with no adverse effects or complications. vOnly one complication was recorded in single infant that did not appear to be related to the maternal MoM implant. To date, there is a lack of consensus as to whether MoM hip arthroplasty implants are to be avoided in the child-bearing female population and whether they constitute a hazard to the fetus in utero. Both chromium and cobalt ions were markedly reduced in levels when transitioning from maternal to cord blood. In particular, chromium showed a greater reduction on average than cobalt (78% vs . 34%). Based on the current evidence, there appears to be no correlation between the presence of metal ions in umbilical cord blood and complications, as none of the infants experienced abnormalities uniquely attributable to the presence of metal ions.

Patent Vitellointestinal Duct Presenting as a Paraumbilical Abscess Along with Intestinal Obstruction in an Adult: a Case Report

The persistence of embryonic vitelline duct occurs in about 2% of the population. Patent vitellointestinal duct (VID) is a rare condition in adults. This anomaly may remain asymptomatic throughout life or may present with umbilical sinus, abscess, fistula, intussusception, and various other intraabdominal complications. We present here an interesting case of 32-year-old man with patent VID presenting as paraumbilical abscess along with intestinal obstruction caused by marked inflammatory changes and adhesion. This patient was managed successfully with excision of the entire duct along with the wedge of ileal attachment. Such rare presentation in an adult has not been reported earlier to the best of our knowledge. Simple incision and drainage of abscess without excision of patient VID would not result in complete treatment of this condition. Therefore, surgeons and radiologists should have high index of suspicion of this uncommon presentation as it is likely to be missed.

Mothers' and Caregivers' Knowledge and Experience of Neonatal Danger Signs: A Cross-Sectional Survey in Saudi Arabia.

Introduction The majority of neonatal deaths in developing countries occur at home. Many of these deaths are related to late recognition of the signs of a serious illness by parents and a delay in the decision to seek medical care. Since the health-seeking behavior of mothers for neonatal care depends on the mothers' knowledge about WHO recognized danger signs, it is essential to investigate their knowledge of these signs. Objective To investigate the knowledge and the experience of mothers and caregivers towards the WHO suggested neonatal danger signs. Methods A community-based study was conducted on mothers who had delivered or had nursed a baby in the past two years. Results A total of 1428 women were included in the analysis. Only 37% of the participant's knowledge covered three or more danger signs. The frequently reported participants' knowledge of danger signs in this study was for yellow soles (48.0%), not feeding since birth or stopping to feed (46.0%), and signs of local infection (37.0%). The majority (69.0%) of the participants had experienced at least one of the danger signs with their baby. The noteworthy frequent reports of the participants' experiences were for yellow soles (27.0%), not feeding since birth or stopping to feed (25.0%), and umbilical complications (19.0%). Conclusion The proportion of mothers with knowledge of at least three neonatal danger signs is low. There is a need for developing interventions to increase a mother's knowledge of newborns danger signs.

Perinatal injuries of the fetal nervous system and contributory factors

The issue of perinatal injury of the central nervous system and birth trauma draws close attention of various specialists. The objective: to identify the effect of extragenital pathology of the pregnant woman and obstetric factors on the formation of perinatal CNS injuries and traumatic injuries of the newborn. Materials and methods. The authors studied ante- and intranatal risk factors for perinatal CNS damage and birth trauma in 183 babies in severe or moderately severe condition (main group) born in the City Clinical Perinatal Center in 2011–2017. There were assessed the clinical manifestations and results of instrumental studies. The control group was formed by the case – control type of 183 women in labor and their children without birth injuries. The results. There were revealed the most significant risk factors for the formation of perinatal CNS injury and birth trauma of the newborn: a high frequency of pregnancy complications (100%), extragenital diseases (90.2%), urogenital infections (33.3%), umbilical cord pathology (33.3%) and other complications of labor (42.1%). The conclusion. The complications of pregnancy and childbirth, extragenital diseases, urogenital infections contribute to the frequency of perinatal CNS damage and development of birth trauma.

Risk factors of stillbirth in Yemen.

Yemen has the highest stillbirth rate among the Arab countries. However, the risk factors of this high rate are lacking. This study aimed to determine the maternal, newborn, and service related risk factors for stillbirths at the main maternity hospital in Sana'a city. A case-control study was conducted in the main maternity hospital in Sana'a city, Yemen. Case and controls were selected prospectively during the study period. Cases were women who delivered stillbirths after 24 weeks of gestation. Risk factors data for mothers and their neonates were collected using face-to-face interview and data abstraction from medical records. The study included 101 women with stillbirths and 202 women with singleton live births. Mothers older than 35 years (Odds ratio (OR) = 4.9) and those with low level of education were significantly more likely to give stillbirths. Prolonged labor (OR = 5.8), mothers' anemia (OR = 2.1), less than 4 antenatal visits (OR = 5.1) and meconium stained amniotic fluid (OR = 11.5) were significantly associated with increased odds of stillbirth. Prematurity (OR = 27), umbilical complications (OR = 6.4), low birth weight (OR = 17.7), and congenital complications (OR = 40.6) were significantly associated with higher odds of stillbirths. This study identified many risk factors of stillbirth that are amenable to intervention. Encouraging women to deliver at health facilities, providing better management of obstetrical complications, proper antenatal care, and prompt referral services are essential for reduction of stillbirths in Yemen.

Inner Scar Umbilicus: New Horizons for Vertical Abdominoplasty.

It is reasonable that deflated tissue in massive weight loss patients may demand not only lifting but also some extent of central body tightening, by the fleur-de-lis procedure. Although achieving nice contouring results, poor visible scars, including umbilical complications, have restricted the indications for the anterior vertical approach. The purpose of this article is to present the authors' experience with the inner scar umbilical reconstruction, reflecting overall results in vertical abdominoplasties. Massive weight loss patients who underwent fleur-de-lis abdominoplasties with the inner scar umbilicus were reviewed retrospectively. The original stalk was resected along with the surgical specimen, and two marked parallel skin flaps were kept and sutured against each other into the deep medial fascia, to reconstruct the umbilical base. Additional sutures were made to approximate fat tissue immediately under and above it, enhancing a deepening effect. Conventional upper and lower vertical closure helped to establish the tridimensional shape of the new navel. One hundred ten consecutive patients were studied, and 52 (47 percent) presented small inflammatory exudate arising from the inner suture, which resolved with conservative dry dressings. No further umbilical complications such as infection, necrosis, dehiscence, widening, or stenosis were reported, and all patients showed natural and scarless new navels with nice shapes and correct position. The inner scar umbilicus is a simple, safe, and reproducible technique, presenting low complication rates with sustainable and natural results. High-quality navel reconstruction favors the indication of vertical abdominoplasties, especially for post-bariatric surgery body contouring. Therapeutic, IV.

Transumbilical laparoscopic cholecystectomy

Background: Single port surgery and transumbilical surgery are progressing rapidly. The advantages of the cosmetic appearance of this surgery encourages the surgeon to do it which has good acceptance from the patients. Moreover transumbilical laparoscopic cholecystectomy has the miratus of the single port surgery and traditional laparoscopic surgery. Single port surgery seemed to be expensive more than traditional laparoscopic surgery. Transumbilical Laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). Aim: Hereby, we report of the initial clinical experiences in Saudi Arabia with this new technique. Ten cases of gallbladder stone are selected for this new technique. Materials and Methods: Tow curved intra-umbilical incision was made with 5mm port for camera (30 degree angle) and 8mm working port. Two separate incision 2mm each at right upper quadrant. Dissection was performed using an electric cautery hook and an endograsper. Result: Nine out of ten procedures were completed successfully and one case converted to conventional laparoscopic cholecystectomy because acutely inflamed. Average operative time 48 min with minimal blood loss. Postoperative follow-up did not reveal any umbilical wound complication. Conclusion: Therefore, transumbilical laparoscopic cholecystectomy is feasible and a promising alternative method as less scar in abdominal surgery for the treatment of some patients with gallbladder stone. No extra cost or special instruments are used. Moreover, we reduce the risk of the post single port hernia surgery.

A Single Institution Study of Umbilical Vein Complications and Necrotizing Enterocolitis in Premature Infants

A Single Institution Study of Umbilical Vein Complications and Necrotizing Enterocolitis in Premature Infants

Predictors, Classification, and Management of Umbilical Complications in DIEP Flap Breast Reconstruction.

In recent years, the deep inferior epigastric perforator (DIEP) flap has become the workhorse flap for autologous breast reconstruction. Despite increased reports on DIEP flaps, umbilical complications have not been previously studied. The aesthetics of the umbilicus dictates the beauty of the abdomen, and it is critical for plastic surgeons to minimize the scarring of the umbilicus. In this study, we retrospectively reviewed patients who underwent DIEP flaps to determine the predictors of umbilical complications, and created a classification system of these wounds. Retrospective review of 323 patients who underwent DIEP flap surgery from 2009 to 2016 was performed. Umbilical stalk heights, widths of fascial diastasis, and abdominal wall thicknesses were measured from computed tomographic scans. Data regarding demographic and patient characteristics were collected. Of the 323 patients, there were 58 patients that had umbilical complications (18 percent). These patients had statistically higher body mass indexes, heavier flaps, and thicker abdominal walls (p < 0.05). Also, they had statistically higher umbilical stalk heights (29.3 mm versus 18.7 mm), and analysis showed that the likelihood ratio of having umbilical complications was 2.05 at 20.1 mm, 3.05 at 25.4 mm, and 6.43 at 30 mm. Logistic regression analysis revealed that umbilical stalk height, fascial diastasis, age, procedure time, and flap weight were significant predictors (p < 0.05). Umbilical complications in patients undergoing DIEP flap surgery for breast reconstruction have not been previously studied. Our study shows that the umbilical stalk height plays a significant role, and umbilical wounds can be classified into five types: no wound, minor wound, wound dehiscence, partial necrosis, and total necrosis. Therapeutic, III.

Anahtar-kilit paternli fleplerle yeni bir umblikoplasti tekniği

Objective: The umbilicus is a significant component of the abdomen. The size, position, depth, and shape of the umbilicus, as well as the location of the scar, are very important. While various techniques have been described in order to obtain an aesthetically appealing umbilicus, surgeons still frequently encounter complications such as visible scars and scar contractures. We present a technique that can avoid these complications while also fulfilling the aesthetic umbilicus criteria. Materials and Methods: Between 2011 and 2014, 18 female patients underwent both abdominoplasty and umbilicoplasty, which was performed using our technique. During abdominoplasty, the umbilicus was separated from the abdominal skin as a three-armed star and inserted in a Y-shaped incision. The patients were asked to evaluate and rate their new umbilici in terms of shape, depth, location, and scaring. Results: The mean follow up period was 20 months. No umbilical complications, such as hypertrophic scarring, were observed. In general, 80% of the patients gave the procedure an 8-point rating out of a possible high of 10-point rating, indicating their satisfaction with the results. Conclusion: In this described technique, the umbilicus is small, shallow, and oval, and the scar is less visible. The incidence of the most frequent complications, such as scar contracture and umbilical stenosis, occurs less often in our safe and versatile technique.

Bilateral hydrocele. Uncommon clinical presentation of primary testicular lymphoma in the elderly.

Primary testicular lymphoma (PLT) represents 5% of testis tumors, the incidence increases in patients older than 60 years of age. Bilateral hydrocele is an unusual clinical presentation. Relapse in the central nervous system and in the contralateral testis is often observed. The US shows hypoechoic nodular lesions with a complete structural involvement of didymus and hypervascularization at Color Doppler. Orchiectomy should be performed in all cases as it is indispensable for the histopathological diagnosis and to characterize the immunophenotypic features. The most common histotype is diffuse large-B cell lymphoma. Combined biological approach and chemotherapy with rituximab and doxorubicin has radically changed the prognosis of disease. The authors report two patients of 81 and 82 years-old who referred for evaluation of massive bilateral hydrocele causing severe limitation of deambulation. Negative cytological findings for neoplastic cells in the scrotal effusion made difficult the differential diagnosis between inflammatory and malignant disease. Histopathologic findings made a diagnosis of high grade diffuse large B-cell NHL, respectively stage IV-E and stage III-E. The 82 years old patient was treated with 6 chemotherapy cycles of rituximab, cyclophosphamide, vincristine, prednisone. The exitus was dued to the umbilical hernia complications. In the 81 years old patient, cognitive deficit and severe impairment of general conditions constituted an absolute contraindication to polychemotherapy treatment. Rapid tumor progression led the patient to exitus 2 months after diagnosis. In both patients the delayed diagnosis of PLT was probably due to the reduction of welfare protection in the elderly with adverse social conditions.