The versatility of the transumbilical approach for laparotomy in infants

Background/purpose Although the transumbilical approach became very popular for pyloromyotomy, it has not been widely used in other procedures in children. The aim of this work was to evaluate the safety and the versatility of this approach for laparotomy in infants.
Patients and methods All hemodynamically stable neonates and infants with gastrointestinal surgical problems or pelvic or abdominal cystic masses were considered candidates for this approach. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline in a cephalic or caudal direction depending on the site of the lesion. The bowel or the mass was delivered outside the peritoneal cavity, and the procedure was completed in the standard open manner. Patients were evaluated with regard to the feasibility of the surgery and or any difficulty to complete the surgery, any complications related to the approach, and the cosmetic outcome.
Results A total of 141 infants underwent transumbilicallaparotomy during the period from June 2008 to December 2013. The primary pathology was hypertrophic pyloric stenosis (n= 65), duodenal, small-intestinal atresia/stricture (n =22), colonic atresia (n= 2), malrotation with/without volvulus (n= 10), ovarian cysts (n= 12), intussusception (n= 9), spontaneous intestinal perforation (n =7), remnants of vitellointestinal duct (n =4), mesenteric cysts (n= 3), patent urachus (n= 3), postoperative complications of strangulated inguinal hernia (n= 3), and complications in ventriculoperitoneal shunts (n= 1). Their age ranged from 1 day to 22 months. The operating time ranged from 30 to 120 min. Three patients required transverse extension of the wound. Two (1.4%) patients developed dehiscence of the wound that required wound closure. Five (3.5%) patients had superficial periumbilical cellulitis and wound infections, and one patient had suture reaction treated conservatively. Late complications (adhesive intestinal obstruction) occurred in three (2%) patients. Parents were very satisfied with the final cosmetic outcome.
Conclusion The transumbilical approach is both afeasible and a safe approach for a broad spectrum of surgical procedures in neonates and infants. The cosmetic results are excellent.