Umbilical reconstruction after repair of large umbilical hernia: the "lazy-M" and omega flaps

A simple and easy-to-perform technique of umbilical reconstruction after repair of a large umbilical hernia is described. Two opposing skin flaps, an upper inverted Omega shaped flap, and a lower, lazy M-shaped flap were designed to create a deep, 3-dimensional, normal-appearing umbilicus in identical twins.     

Use of an opened umbilical vein patch for the reconstruction of the injured biliary tract

Background/Purpose When iatrogenic biliary tract injury occurs, there is the risk of complications such as bile leak and biliary stricture, and hepaticojejunostomy is the conventional procedure used for injury repair. However, this procedure can be complicated by retrograde biliary tract infection and the procedure can destroy the normal anatomical structure. Methods We report here a method of end-to-end biliary tract reconstruction that uses an opened umbilical vein (OUV) patch and two stents to reduce bile leakage and biliary stricture formation following injury to the common bile duct or right main bile duct. The postoperative courses of four patients are reviewed. Results In two of the patients, there was a small amount of postoperative bile drainage (for 3 days in the first patient and 2 days in the second patient). Of the two stents, the first stent was removed 1 month postoperatively, and the second stent at 2 to 3 months postoperatively. Three patients have returned to normal activity without symptoms after 44, 62, and 93 months, respectively. One patient died of a liver tumor recurrence in the fifth postoperative month, without a biliary problem. Conclusions An OUV patch for end-to-end biliary reconstruction reduced the volume and duration of bile leakage. Further research is needed to accurately evaluate the stenting period so as to reduce its duration.     

Spontaneous endometriosis associated with an umbilical hernia: A case report and review of the literature

IntroductionUmbilical endometriosis occurring in the presence of an underlying hernia is extremely rare and presents a diagnostic challenge for the general surgeon. We present an interesting case and perform a comprehensive review of the literature.MethodsMedline and PubMed were queried for all cases of spontaneous umbilical endometriosis associated with an umbilical hernia. Data was analyzed and is presented along with an interesting case.ResultsOnly 7 cases have been reported in the literature. Median age was 38 years. Time to presentation was long (up to 5 years) and the majority had cyclical symptoms related to menstruation. All patients, including our case, were treated surgically.DiscussionSpontaneous umbilical endometriosis with an underlying hernia is often missed preoperatively. Preoperative suspicion warrants axial imaging for better operative planning and patient counseling. Surgery consists of enbloc excision of the umbilicus, implant and the hernia sac to avoid residual disease and reduce recurrence. The hernia defect can be repaired primarily or using mesh and the umbilicus reconstructed using skin flaps if necessary.ConclusionsSurgery is the mainstay of therapy for umbilical endometriosis associated with an underlying hernia. Clinical suspicion warrants preoperative imaging, and follow-up with a gynecologist is essential to address any pelvic disease.     

An umbilical reconstruction using subcutaneous pedicle flap

An umbilicial reconstruction using subcutaneous pedicle flaps is described. With this method, a cosmetically satisfactory result can be easily achieved with little tissue sacrifice. In this procedure the abdominal wall is not incised deeply, thus perforation of the abdominal wall is prevented.     

Incarceration of a sessile uterine fibroid in an umbilical hernia during pregnancy

On rare occasions, uterine fibroids complicate pregnancy. More commonly, fibroids exert a mass effect that either prevents implantation of an egg or becomes problematic as a fetus grows. Less frequently, pregnancies are affected by fibroid herniation through a fascial defect. Several publications describing herniation of pedunculated fibroids exist, two of which were in umbilical hernia sacs. There is, to our knowledge, only one publication describing the presence of a sessile uterine fibroid in an umbilical hernia. This case report adds to the literature by describing a 34-year-old primigravid woman with an umbilical hernia that contained a sessile uterine fibroid and provides parameters that can be used in the initial evaluation of a pregnant woman with an abdominal wall hernia.     

腹腔镜脐环缝扎术治疗小儿脐疝的体会

目的:探讨腹腔镜脐环缝扎术治疗小儿脐疝的临床疗效。方法:回顾分析为21例脐疝患儿行腹腔镜脐环缝扎术的临床资料。结果:21例手术均获成功。手术时间20～45 min,平均32.5 min;术中均无出血,术后康复快。术后18例患儿随访6～72个月,无复发或肠粘连、肠梗阻等并发症发生。结论:腹腔镜脐环缝扎术治疗小儿脐疝安全、有效,手术微创、美观,值得推广应用。     

A uterine fibroid presenting as an incarcerated umbilical hernia during pregnancy

Uterine leiomyomas (fibroids) affect 2.6% of pregnancies. They are usually silent, but on occasions can complicate pregnancies. A case of a 30-year-old pregnant woman with a uterine fibroid incarcerated in an umbilical hernia is presented. This is the second reported case of a fibroid in pregnancy with such a presentation.     

成人脐窦五例诊治报告

目的 探讨成人脐窦病因、诊断方法及治疗原则.方法 报告1995年9月至2013年11月收治的5例患成人脐窦的临床资料.男性4例,女性1例.年龄22～39岁,平均29岁.病人因脐部出现绿豆至黄豆大小的鲜红色肿物,脐部渗液及异味就医.门诊3例以“脐茸”收治,2例以“脐窦”收治.所有病例均给予手术治疗.结果 5例病人术后均痊愈出院,平均住院日16.2 d.1例病人手术后发生切口感染,腹腔局限性脓肿形成,住院达37 d.5例病人手术标本均显示病灶内存在黏膜上皮细胞、较多典型的呈岛状的腺体结构,结合临床,病理报告提示:脐窦.结论 成人脐窦发病罕见,正确的诊断和治疗方法是获得满意治疗效果的关键.     

Reconstruction of the Umbilicus Using a Reverse Fan-Shaped Flap

The goal of the reconstruction for umbilical absence is to obtain a natural three-dimensional appearance of the umbilicus with minimal operative scarring. This paper presents two cases of umbilical reconstruction using a reverse fan-shaped flap. In both cases, the umbilicus was lost during surgical procedures on the abdominal wall when the patients were newborns. We performed this technique in both cases. This technique is simple and safe. With this technique, a permanent umbilical depth and ring can be obtained without any complications.     

硬膜外阻滞对剖宫产胎儿脐血流的影响

目的 观察剖癌产术硬膜外阻滞时对胎儿脐血流的影响。方法 采用多普勒超声仪,探头频率３．５ＭＨｚ,麻醉前测脐静脉,脐动脉,直径。记录ＵＡ收缩期峰值速度,舒张期最低速度 ,平均速度,算出Ｖｍａｘ及Ｖｍｉｎ之比,搏动指数及阻力指数。脉冲多普勒取样线与脐动脉长轴夹角θ≤２０度     

Current concepts on adult umbilical hernia

Summary Umbilical hernia has not received as much attention as other abdominal wall defects. Prevalence in the adult population is 2% and is much more common in cirrhotic patients and obese middle-aged multiparous women. Adult umbilical hernias have an acquired origin as a consequence of increases in pressure (pregnancy, ascites, etc.), the pull of the abdominal muscles, and the deterioration of connective tissue. Attention needs to be paid to the development of umbilical hernias after laparoscopic trocar insertion. All trocar sites larger than 10 mm should be properly closed after operation. The high morbidity and mortality associated with incarcerated umbilical hernias demand an elective repair in all circumstances. There is a lack of control trials evaluating the results of surgical repairs based on the tight overlapping closure of the umbilical ring described by Mayo, while recurrence after umbilical herniorrhaphy is thought to be a common event. The possibility of the application of biomaterials to the surgical correction of umbilical hernias that have been successfully used in the inguinal canal opens a new field for further clinical investigation. Control studies with long follow-up are now required in order to establish evidence based umbilical surgery.     

皮管法鼻再造术探讨

目的:探讨皮管法鼻再造的手术相关技术和适应证。方法:自1999年以来,我们应用上臂皮管、胸部皮管、腹部皮管临床治疗18例鼻缺损患者。总结相关技术及术式的优缺点和适应证。结果:本组18例患者手术均获成功,外形及通气效果良好。随访3￣12个月,皮瓣无明显回缩。结论:对于此组额、面部大面积烧伤的病人,皮管法鼻再造是首选治疗方案。     

An unusual case of umbilical hernia rupture with evisceration

Umbilical hernia is a common pediatric diagnosis for which the initial management is usually nonoperative. The high incidence of spontaneous closure and the infrequency of complications in the first few years of life justify this conservative management strategy. The authors present a case of a 5-month-old girl with a history of prematurity and prolonged ventilatory support, who subsequently experienced bowel evisceration via a previously uncomplicated umbilical hernia.