Vertical Umbilical Incision Achieves Better Cosmesis Than Periumbilical Incision in Neonates and Infants

Abstract

Purpose: The transumbilical approach is widely used for minimally invasive surgery in children. We compared herein the postoperative cosmesis between two types of transumbilical approach: a vertical incision versus periumbilical incision.

Methods: Patients with a transumbilical laparotomy before age one year were prospectively enrolled between January 2018 and December 2020. A vertical incision or periumbilical incision was chosen at the surgeon's discretion. After excluding patients receiving a relaparotomy via another site, a questionnaire about the appearance of the umbilicus was completed by the patients' guardians at postoperative month 6 to assess satisfaction and determine the visual analog scale score. A photograph of the umbilicus was taken while the questionnaire was being administered for later assessment by surgeons blinded to the scar and umbilical shape.

Results: Forty patients were enrolled; 24 patients received a vertical incision while 16 received a periumbilical incision. The incision length was significantly shorter in the vertical incision group (median: 2.0; range: 1.5-3.0 cm vs. median: 2.75; range: 1.5-3.6 cm) (p = 0.001). The patients' guardians reported significantly higher satisfaction (p = 0.002) and higher scores on the visual analog scale (p = 0.046) in the vertical incision group (n = 22) than in the periumbilical incision group (n = 15). The surgeons' evaluation was associated with significantly more patients with a vertical incision than with a periumbilical incision achieving a cosmetically preferable outcome, including an invisible or fine scar and a normal umbilical shape.

Conclusion: A vertical umbilical incision can provide better postoperative cosmesis than a periumbilical incision.

Keywords: children; cosmetic outcome; minimally invasive surgery; umbilical approach; umbilical incision.

Figure 1. Transumbilical laparotomy via vertical incision followed by umbilicoplasty.

Image credits: Hirofumi Tomita

Figure 2. Postoperative photographs of the umbilical region at month 6 after transumbilical laparotomy.

A: After vertical 2.0 cm incision for ovarian cyst at age 1 day; B: After vertical 2.5 cm incision for intussusception at age 9 months; C: After supraumbilical 2.0 cm incision for malrotation at age 9 days; D: After supraumbilical 3.0 cm incision for intussusception at age 11 months