Umbilical Defects Research Articles

Umbilicoplasty in Neonates with a New Technique: Results of 20-Year Follow-Up.

Context:An aesthetically acceptable umbilicus is an important component of the body and absent or dysmorphia may lead to psychological discomfort. Therefore reconstruction of neoumbilicus attains importance in abdominal surgical planning. This innovative surgical creation of umbilicus was planned during the initial surgery of umbilical defects to achieve these goals with minimal scarring.Materials and Methods:Our technique was applied to all 26 cases: primary omphalocele repair (n = 5), abdominal wall reconstructions after conservative management of large omphaloceles (n = 17), large umbilical hernias (n = 3), and one case of patent vitelointestinal duct with redundant skin. All patients were followed up yearly for the aesthetic appearance and clinical photographs were recorded.Results:Technique applied to all 26 patients had excellent cosmesis and long term follow up was very encouraging.Conclusions:All patients had successful abdominal wall closure. Most of the patients had minimal scar of the large hernia repair and the umbilicus was normal looking and well accepted cosmetically.

Double Running Suture Line Repair in Primary Umbilical Hernias - Analysis after 282 Cases

There is an ongoing debate as to which patients presenting with an umbilical hernia should be operated with the sole suture technique or augmented by mesh. After treating most of our patients for a long period uniformly with a double running suture line, the aim of this study was to evaluate the performance of this strategy - especially in patients with larger defects. From 1/2004 to 4/2017, all patients operated on for an umbilical hernia were identified through our hospital information system (KIS). The relevant documents for each case - such as operation and discharge reports, anaesthesia protocol, and information on the clinical course were extracted and the critical parameters entered into a database program (FileMaker® 12.0). Adult patients (≥ 18 y) with a double running suture line, excluding recurrences and surgery simultaneously to minimally invasive interventions, receiving surgery on umbilical defects ≤ 2 cm (size 1) were compared to those with defects > 2 cm (size 2). Long-time results were gathered from the KIS, follow-up investigations, questionnaires and telephone interviews. Chi-square and Mann-Whitney U tests were applied; p < 0.05 was considered significant. 515 operations for umbilical hernias were identified, of which 282 were primary cases with double running suture. The follow-up was 77%. Only cases with follow-up information were considered. Patients with size 1 (n = 147) were significantly younger than patients with size 2 (n = 69; 51 vs. 54 years; p = 0.0012), had a lower BMI (29 vs. 33; p = 0.003) and tended to have lower ASA score (2 vs. 2; p = 0.0837). Complications were seen in 8/147 (5%) vs. 4/69 (6%) cases, respectively (p = 0.9174). The recurrence rate after a median of 4,6 years was in 6/147 in size 1 (4%) vs. 4/69 (6%) in size 2 (p = 0.5759). The use of a double running suture line with non-absorbable material with umbilical hernias led to good results in our patients. Repair of primary umbilical hernias was mostly successful, independently of the size of the defect, even in older patients with greater body weight.

Umbilical Hernia with Evisceration. Two Cases and a Review of the Literature

BackgroundEvisceration of umbilical hernias is an uncommon occurrence whereby the hernial contents break through the skin overlying the sac and skin. Irrespective of cause, sudden evisceration of an umbilical hernia is associated with deterioration and a poor outcome. Case ReportsOur first case was a 42-year-old woman who presented with sudden outpouring of fluid from the umbilicus with omental evisceration. Further evaluation revealed hepatic decompensation caused by hepatitis C infection belonging to Child-Turcotte-Pugh class C. After stabilizing her hemodynamically, she underwent a partial omentectomy with primary repair of umbilical defect. The patient's postoperative course was challenging. She died of septicemia and acute renal failure after 5 days. Our second case was a 40-year-old man who suffered from alcohol-induced cirrhosis, presenting with omental evisceration, belonging to Child-Turcotte-Pugh class C. We performed a primary repair of the hernial defect with peritoneovenous shunting for his intractable ascites. Upper gastrointestinal endoscopy revealed grade I esophageal varices. The patient succumbed to acute variceal hemorrhage with acute renal failure 18 days later. Why Should An Emergency Physician Be Aware of This?In an emergent setting with multiple factors influencing final surgical outcome, it is imperative that management be tailored for each patient. Those with severe encephalopathy or cardiovascular instability must be stabilized before surgical intervention. Central venous and blood pressures need to be closely monitored during resuscitation, as fervent fluid administration may predispose to variceal hemorrhage. It may be prudent to follow the principle of hypotensive resuscitation as in acute trauma cases.

Umbilical Hernia Repair: Overview of Approaches and Review of Literature.

Umbilical hernias are ubiquitous, and surgery is indicated in symptomatic patients. Umbilical hernia defects can range from small (<1cm) to very large/complex hernias, and treatment options should be tailored to the clinical situation. Open, laparoscopic, and robotic options exist for repair, with each having its advantages and disadvantages. In general, mesh should be used for repair, because it has been shown to decrease recurrence rates, even in small hernias. Although outcomes are generally favorable after umbilical hernia repairs, some patients have chronic complaints that are mostly related to recurrences.

A new abdominal wall reconstruction strategy for giant omphalocele

Abstract The mortality rate of giant omphalocele has improved; however long-term follow-up has revealed umbilical defects and deformities after primary closure. We herein report the efficacy of a new abdominal wall reconstruction strategy combining a component separation technique with delayed natural and deep umbilicoplasty.

Optical manipulation and defect creation in a liquid crystal on a photoresponsive surface.

Light-induced modulations of the refractive index and pattern formation are desirable to generate complex photonic structures via exposure to light. Here we show that local modulations of the effective refractive index and reconfigurable defects can be locally induced in a hybridized thin birefringent film of a nematic liquid crystal (LC) on a photoresponsive (generating photoinduced electric fields) iron doped lithium niobate surface via exposure to a focused laser beam. Samples were studied with a tailored imaging approach, which provided the ability to investigate these optically excited, field-induced responses on a microscopic level. Upon exposure with a focused laser beam, the fluent LC was expanded on the substrate's surface and localized field-induced defects were optically created. Both umbilic (central) and line defects were observed. The formation of field-induced umbilic defects was modeled in numerical simulations. In addition, line defects were experimentally studied. It was seen that line defects interconnected the centers of two central defects (field-induced defects, which were present at the upper and lower surfaces of the LC layer). In addition, line disclinations separating reverse tilt domains (caused by the inhomogeneous distribution of the photogenerated fields) were seen. These line disclinations were pinned to the central defects. By exposure with two adjacent focused laser beams two umbilic defects were created side by side and interconnected with a line defect (the line defects pinned to each umbilic defect were joined in a single defect line). An alternative technique is presented to field-induce promising photonic motives (microlenses, resonators, line defects) in a liquid crystalline, hybridized birefringent film on a microscopic scale by using a low-power laser (opposed to the high power necessary to induce optical Kerr responses in a neat LC).

A case report on midline facial cleft associated with ambiguous genitalia and umbilical defect

A case report on midline facial cleft associated with ambiguous genitalia and umbilical defect

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch: interim results of the PANACEA study.

PurposeThis study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP]).Patients and methodsA single-arm, multicenter prospective study of 126 patients undergoing open ventral hernia repair with the PCO-VP was performed. Patient outcomes were assessed at discharge and at 10 days, 1, 6, 12, and 24 months postoperative.ResultsAll patients had hernioplasty for umbilical (n = 110, 87.3%) or epigastric hernia (n = 16, 12.7%). Mean hernia diameter was 1.8 ± 0.8 cm. Mean operative time was 36.2 ±15.6 minutes, with a mean mesh positioning time of 8.1 ± 3.4 minutes. Surgeons reported satisfaction with mesh ease of use in 95% of surgeries. The cumulative hernia recurrence rate at 1 year was 2.8% (3/106). Numeric Rating Scale (NRS) pain scores showed improvement from 2.1 ± 2.0 at preoperative baseline to 0.5 ± 0.7 at 1 month postoperative (P < 0.001), and this low pain level was maintained at 12 months postsurgery (P < 0.001). The mean global Carolina’s Comfort Scale® (CCS) score improved postoperatively from 3.8 ± 6.2 at 1 month to 1.6 ± 3.5 at 6 months (P < 0.001). One patient was unsatisfied with the procedure.ConclusionThis 1-year interim analysis using PCO-VP for primary umbilical and epigastric defects shows promising results in terms of mesh ease of use, postoperative pain, and patient satisfaction. Recurrence rate is low, but, as laparoscopic evaluation shows a need for patch repositioning in some cases, an accurate surgical technique remains of utmost importance.

Unusual urachal remnant disease in a six-month-old golden retriever

A six-month-old male entire golden retriever was presented with an umbilical mass noted by the owners four days before. Clinical examination revealed fever (39.7°C) and an umbilical fistulised abscess. Abdominal...

Laparoscopic Umbilical Hernia Repair

Introduction: Laparoscopic hernia repairs are usually performed in adults because the defects are large and mesh is required. For umbilical hernias in children, an open repair through the umbilicus is common.1 However, there are some circumstances in which the hernia defect is large and a laparoscopic approach may be of benefit to the child. Materials and Methods: This video shows a repair done in a 16-year-old male with a large, umbilical hernia defect. Access to the right lower quadrant was achieved by an open Hasson technique and a Step™ trocar (Auto-Suture; Covidien) was placed using a 5 mm incision. Pneumoperitoneum was established using 5 L/minute of carbon dioxide under 15 mm Hg of pressure, then a 30° telescope camera was inserted into the peritoneal cavity. Next, a 2 mm incision was made at the umbilical scar, and under camera observation, a GraNee needle with 2-0 Ethicon suture was introduced and inserted ∼0.5 cm from the defect margin. The needle was then withdrawn and reinserted, through the same umbilical incision, across the defect to grab the suture and pull it back up toward the umbilicus. After this process, horizontal sutures were placed across the length of the hernia. Once all the sutures were in place, the abdomen was deflated before pulling the sutures closed, so that there would be no unnecessary tension. Additional sutures were placed afterward with the abdominal cavity under low inflation. Finally, the port was removed and the incisions were closed with interrupted sutures. Results and Conclusions: There were no postoperative complications. At initial follow-up and at 6 weeks, 6 months, and 1 year follow-up, there was no reoccurrence of the hernia. No competing financial interests exist. Runtime of video: 2 mins 34 secs

Trans umbilical laparoscopic access during laparoscopic procedures

Introduction: The advent of laparoscopic surgery is one of the most important advances in modern surgical technique. In order to perform laparoscopic procedures it is necessary to first access the peritoneal cavity and establish a pneumoperitoneum. The placement of the first port remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of this first trocar, several techniques have been reported. We describe a surgical technique that has been developed by our surgical group that provides a quick, safe, and reliable initial access to the peritoneal cavity that is accompanied by excellent functional and cosmetic results. Methods: Retrospective cohort of patients who underwent various laparoscopic procedures by our surgical group using our modified open technique for accessing the peritoneum from January 2000 to September 2012. We excluded patients who had a prior midline laparotomy with involvement of the umbilicus, but not those with previous transverse umbilical herniorrhaphies. Results: We identified 963 patients (M = 419; F = 544) in the study period. Average age of the patients was 40 years (range: 15-83). Median follow up of 2.8 years (range: 6-144 months). No complications occurred during the insertion of the first trocar. A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. Postoperative complications occurred in 39 patients (4.0%). The most common complication was a postoperative seroma, which occurred in 24 patients (2.4%). Superficial surgical site infection occurred in eight patients (0.84%), hematoma in two patients (0.21%), and incisional hernias in the umbilical port site in five patients (0.51%). The average time to access the peritoneal cavity was 1.5 minutes (range: 1-7). Conclusions: We describe a modified open technique for accessing the peritoneal cavity through a small congenital umbilical defect that is almost universally present. This technique is quick, safe, reliable, simple, and easy to learn. It is associated with minimal morbidity and has excellent cosmetic results. Based on our experience, we believe that this method provides surgeons with an effective and safe way to insert the first trocar and we recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

Large-scale self-organization of reconfigurable topological defect networks in nematic liquid crystals.

Topological defects in nematic liquid crystals are ubiquitous. The defects are important in understanding the fundamental properties of the systems, as well as in practical applications, such as colloidal self-assembly, optical vortex generation and templates for molecular self-assembly. Usually, spatially and temporally stable defects require geometrical frustration imposed by surfaces; otherwise, the system relaxes because of the high cost of the elastic energy. So far, multiple defects are kept in bulk nematic liquid crystals by top-down lithographic techniques. In this work, we stabilize a large number of umbilical defects by doping with an ionic impurity. This method does not require pre-patterned surfaces. We demonstrate that molecular reorientation controlled by an AC voltage induces periodic density modulation of ions accumulated at an electrically insulating polymer interface, resulting in self-organization of a two-dimensional square array of umbilical defects that is reconfigurable and tunable.

Umbilical Varix Herniating Through Umbilical Defect and Mimicking Incarcerated Hernia

Umbilical Varix Herniating Through Umbilical Defect and Mimicking Incarcerated Hernia

Porous nematic microfluidics for generation of umbilic defects and umbilic defect lattices

Porous nematic microfluidics is shown to produce diverse fluid states --umbilic defect structures- which emerge as the result of backflow coupling between the flow shear and the fluid orientational field. Structures as diverse as square, triangular, rhombic and even Kagome lattices are found.

Prospective Analysis and Technical Recommendations for Repair of Small Ventral/Umbilical Hernias Using the Ventralex Hernia Patch

Background: Mesh reinforcement of small ventral/umbilical hernias has become increasingly popular over the last decade. The Ventralex TM hernia patch has been evaluated for this purpose in a small number of studies with equivocal results, particularly in relation to post-operative hernia recurrence and mesh-related complications. The aim of this study was to examine the short- and long-term clinical outcomes of the technique, and to address the possible limiting factors. Methods: Open mesh repair following strict surgical methodology was performed on 100 consecutive patients with small ventral/ umbilical hernia defects of 1-3cm in diameter between April 2007 and December 2012. Short-term clinical outcome was obtained at 2- and 6-week post-operative visits, and long-term results were assessed by telephone interview with subsequent clinical review if judged necessary. Immediate post-operative complications, hernia recurrence, pain and Quality-of-Life (QoL) were also evaluated. Results: There were no major short-term complications; minor complications including superficial wound infection and haemoserous wound discharge occurred in 9 patients (9%). The mean long-term follow-up was 37.9 months (range 6-75 months), with no hernia recurrences. No pain or mild pain was reported in 93.6% of patients, and 96.1% reported being satisfied or very satisfied with their repair. Conclusions: This study demonstrates that open repair of small ventral/umbilical hernias using the Ventralex TM patch can be extremely safe and effective, with excellent long-term clinical outcome, when following a meticulous but easily reproducible surgical technique. Those main clinical steps include avoidance of large-sized patches, placing the mesh extraperitoneally (sublay) wherever possible, fixing the positioning straps with minimum tension, and always closing the abdominal fascia defect in front of the hernia patch.

Topical treatment of major omphalocoele: Acacia nilotica versus povidone-iodine: A randomised controlled study.

Background:Conservative management for major omphalocoele with topical agents as escharotics therapy is well established in practice. Different agents have been used in the past, including mercurochrome and alcohol, proved later to be unsafe. The aim of this study is to evaluate the efficacy and safety of the application of Acacia nilotica paste compared to povidone-iodine solution as a primary non-surgical treatment of major omphalocoele.Patients and Methods:A double-blind, randomised study was conducted on 24 cases of major omphalocoele where they were randomly divided into two equal groups; Group A treated with topical application of A. nilotica paste and Group B treated with topical application of povidone-iodine solution. Cases with gastroschisis, ruptured major omphalocoele or minor omphalocoele were excluded from the study. The evaluating parameters were size of the fascial defect in cm, period of mechanical ventilation if needed, time required for full oral feeding tolerance, duration of hospital stay and any short- or long-term complications.Results:There was no statistical significant difference between both groups regarding their gestational or post-natal age, weight and the mean umbilical port defect. Patients from Group A tolerated full oral feeding earlier and had shorter total hospital stay duration than those from Group B, but without a statistical significant difference (P = 0.347 and 0.242, respectively). The overall mortality rate was 33.3% without a statistical significant difference between both groups (P = 0.667).Conclusions:Application of A. nilotica is a safe and effective treatment of major omphalocoele as it was associated with rapid full enteral feeding tolerance, short duration of hospital stay and low mortality rate.

Hybrid NOTES cholecystectomy - A safe and economic innovation

Background: Minimally invasive techniques have revolutionized surgery, making great impact in terms of reduced postoperative morbidity and shorter hospital stay by reducing abdominal wall trauma. Recent introduction of single incision laparoscopic surgery has introduced another debate. After establishing safety profile at the local level, we now present another modification of single incision cholecystectomy. Findings: These procedures were performed on two female patients diagnosed with gallstone disease and scheduled to undergo elective single incision laparoscopic surgery (SILS). Standard laparoscopic ports, straight laparoscopic instruments and 5mm 30° scopes were used. The scope was inserted per vaginum using a long 5mm laparoscopic port. The operation was performed using two instruments introduced through the umbilicus using two standard 5mm laparoscopic ports. The 5mm umbilical fascial defects did not require formal closure. No intra-operative or postoperative complication was reported. Operation was made technically easy because this modification provided greater flexibility of movement for operating instruments by decreasing crowding at the umbilical port without compromising on postoperative recovery or cosmetics. Conclusion: The use of laparoscope through vagina is a viable and safe modification of single incision laparoscopic surgery.

Symmetry breaking of nematic umbilical defects through an amplitude equation.

The existence, stability properties, and bifurcation diagram of the nematic umbilical defects is studied. Close to the Fréedericksz transition of nematic liquid crystals with negative anisotropic dielectric constant and homeotropic anchoring, an anisotropic Ginzburg-Landau equation for the amplitude of the tilt of the director away from the vertical axis is derived by taking the three-dimensional (3D) to 2D limit of the Frank-Oseen model. The anisotropic Ginzburg-Landau equation allows us to reveal the mechanism of symmetry breaking of nematic umbilical defects. The positive defect is fully characterized as a function of the anisotropy, while the negative defect is characterized perturbatively. Numerical simulations show quite good agreement with the analytical results.

Preliminary experience with laparoscopic repair of associated inguinal and umbilical hernias in children.

The authors report their preliminary experience in laparoscopic repair of associated inguinal and umbilical hernias in children. Twenty-six patients affected by the association of inguinal and umbilical hernia with an umbilical defect larger than 5mm underwent a laparoscopic procedure. A 5-mm trocar was placed through the umbilical defect for the optic. To fix the trocar to avoid loss of carboperitoneum, we fashioned and tightened a purse-string non-absorbable suture with a sliding knot around the defect. In this manner, we ensured the trocar, fixing it and avoiding any loss of CO2, proceeding safely to the laparoscopic IH repair, by means of two additional 3 mm operative trocars. At the end of the inguinal herniorrhaphy, the previously fashioned purse-string suture was tightened to repair the umbilical defect. The mean operative time for the repair of associated inguinal and umbilical hernias was 30.1±7.4min in cases of unilateral inguinal hernia and 39.5±10.6 for bilateral inguinal hernia. Follow-up ranged from 8 to 32months. Neither intra- nor post-operative complications nor recurrences were seen. This small sample suggests that this simple method is safe, effective and might be useful for pediatric surgeons performing laparoscopic repair for inguinal hernia in presence of an associated UH with a statistically significant decrease of operative time.

Multidetector Computed Tomographic Angiography Imaging of Pentalogy of Cantrell

A 4-day-old female mildly cyanotic neonate presented clinically with ventral herniation of the heart to the anterior abdominal wall and umbilical defect containing bowel loop (Figure [A] and Movie I in the online-only Data Supplement), raising suspicion of pentalogy of Cantrell. Echocardiogram of the ectopic heart, although technically difficult, revealed overlap of the ascending aorta with small-caliber partially visualized main pulmonary artery arising from the ventricle (Figure [B]). Multidetector computed tomographic angiography (MDCTA) confirmed the diagnosis of pentalogy of Cantrell, which consisted of ectopia cordis with rightward apex containing ventrally herniated single ventricle with right- sided atrioventricular valve atresia protruding through the defective anterior diaphragm anterior to the liver, omphalocele, lower sternal and ventral thoracoabdominal wall defects, and multiple cardiac anomalies (Figure [C through E] and Movie II in the online-only Data Supplement). Cardiovascular anomalies included single ventricle with right-sided atrioventricular valve atresia giving rise to tetralogy of Fallot–type conotruncus with diffusely narrowed main pulmonary artery. Additional anomalies included large secundum atrial septal defect, absent left pulmonary artery originating from the undersurface of the aortic arch …