Double half-cone flap umbilicoplasty: a new technique for the proboscoid umbilical hernia in children.

OBJECTIVE: Although many techniques have been described for reconstruction of the protruding umbilicus in children with umbilical hernia, we present a simple new technique for umbilicoplasty. METHODS: Ten children (six males and four females) with umbilical hernias and protruding skin were operated upon. Operative description consists of amputation of the protruding umbilical skin, leaving two unequal half-cones, a short cephalic half-cone (0.5 cm) and a long caudal half-cone (1 cm). These two half-cones are fashioned, closed, and inverted to constitute the new umbilicus following a classic hernia repair. RESULTS: The early results were excellent in all cases with no infection and no ischaemic changes encountered in the skin of the reconstructed umbilicus. Follow-up periods between 6 and 18 months revealed a cosmetically pleasing shape of the umbilicus. Only one case developed hypertrophy of the resulting scar. CONCLUSION: We present our initial experience with the new technique. This new technique provides a good solution for reconstruction of the protruding umbilical skin. Our double half-cone flap umbilicoplasty technique is easy to learn and to perform.

Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country.

PURPOSE: We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources. METHODS: Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed. RESULTS: We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months. CONCLUSIONS: Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.