Morphologic Variations of the Umbilical Ring, Umbilical Ligaments and Ligamentum Teres Hepatis

Abstract

PurposeThe varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures.Materials and MethodsThe anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope.ResultsOne case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing.ConclusionThese results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.

Umbilical shapes predict future protrusion in pediatric umbilical hernias

“…Anatomical variations in umbilical structures have been well reported. [22][23][24] However, the relationship between anatomical variations and UHs in adults has been reported less often. 23,24 Furthermore, this relationship in pediatric UH case has never been described.…”

“…[22][23][24] However, the relationship between anatomical variations and UHs in adults has been reported less often. 23,24 Furthermore, this relationship in pediatric UH case has never been described. We considered that the highly inflated balloon umbilici are characterized by skin fixed around the umbilical edge, which forms the neck of the balloon shape, and an expanded thin skin envelope.…”

“…The caudal skin resists the protrusion of the UH and appears to be in the shape of a crescent pointing caudally. This type is related to the anatomical structures because the inferior border of the umbilical ring is where the ligamentum teres hepatis, two lateral umbilical ligaments, and urachus fuse; [22][23][24] other directions of a crescent were rare. In this study, nine patients had unclosed UHs: seven patients had the crescent type, one had the highly inflated balloon type, and one had the normal type.…”

Suture repair of umbilical hernia during caesarean section: a case–control study

“…There was a tendency for a higher procedure satisfaction in the IR subgroup (10/10 points vs. 6/10 points, p = 0.087). Both the median body image and cosmesis (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) 0.038* score showed a higher level of functioning in the IR group (p = 0.02; p = 0.04) ( Table 3).…”

“…Pregnancy represents a significant aetiological factor in the development of umbilical hernia [1], but the prevalence of umbilical hernia during pregnancy is largely unknown [2] and probably underestimated. Widening of the linea alba during pregnancy leading to a diastasis recti abdominis evokes pull forces on the umbilical ring which might lead to a symptomatic umbilical hernia [3][4][5]. There is still a debate about the ideal timing of hernia repair in pregnant women.…”