Surgical management of proboscoid herniae

A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias

“…Umbilical hernia repair involves either a circumumbilical or intraumbilical skin incision, dissection of the hernia sac, and suture closure of the fascia. Proboscoid umbilical skin can be left to contract on its own, although some authors have suggested minimizing the excessive skin by a variety of suture and/or flap methods [1][2][3][4][5][6][7][8][9][10][11]. The goal of surgery for these hernias is to definitively close the fascial defect while optimizing the aesthetic result of the wound and minimizing complications.…”

Umbilicoplasty with 3 triangular skin flaps and excised diamond-shaped skin flap

“…A 3-triangular-skin-flap technique was described by Reyna et al [5] in 1987, both to gain a more natural contour and to prevent necrosis of the distal tips of the skin flaps. A 4-triangular-skin-flap approach to umbilical defects and use of a laparoscopic umbilical port were subsequently described by Kaneko and Tsuda [6] in 2004.…”

“…The 3-and 4-triangular-skin-flap techniques have previously been reported to result in natural postoperative umbilical scars, as the incision does not exceed the contour of the umbilical ring [4][5][6]. However, if the umbilical hernia is very large, the umbilicus remains relatively large postoperatively [6].…”

“…Reyna et al [5] reported that necrosis of the tip of the flaps can be prevented if the length of the flap is less than the width at the base. Although we decided on a flap length of 1.5 cm, neither necrosis nor significant infection of the flap tip has not been observed.…”

“…We modified the 3-and 4-triangular-skin-flap techniques for umbilical diseases [4][5][6] and devised a new umbilicoplasty technique using 3 skin flaps and an excision of a diamond-shaped skin flap to diminish the diameter of the umbilicus and to gain a cosmetically acceptable umbilicus, even for large umbilical hernias.…”