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Updated: Aug 16, 2025
Postoperative Ileus Murine Model
Published on: July 12, 2024
Circumumbilical incision for neonatal abdominal surgery: additional skin incision when there is difficulty in
Yoichi Nakagawa1, Akinari Hinoki1, Hizuru Amano1
1Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Circumumbilical incision (CUI) for neonatal intestinal surgery may increase the risk of non-anastomotic intestinal perforation. Surgeons should extend the skin incision if needed to avoid injuring the delicate neonatal intestine.
Area of Science:
- Pediatric Surgery
- Neonatal Surgery
- Gastrointestinal Surgery
Background:
- Neonatal intestinal anastomosis is a critical surgical procedure.
- Surgical incision choice impacts patient outcomes and cosmesis.
- Circumumbilical incision (CUI) is an alternative to transverse incision (TI) in neonates.
Purpose of the Study:
- To compare the safety and effectiveness of CUI versus TI in neonates undergoing intestinal anastomosis.
- To identify potential complications associated with CUI in neonatal intestinal surgery.
Main Methods:
- Retrospective case-control study of 70 neonates undergoing intestinal anastomosis between 2003 and 2020.
- Patients were divided into CUI (n=25) and TI (n=45) groups.
- Comparison of postoperative complications and surgical outcomes.
Main Results:
- Intestinal perforation at non-anastomotic sites occurred significantly more in the CUI group (12%) than the TI group (0%) (p=0.042).
- No significant differences were observed in anastomotic leakage, stricture, time to feeding, operative time, or blood loss.
- CUI may be associated with a higher risk of non-anastomotic perforation.
Conclusions:
- Circumumbilical incision in neonatal intestinal surgery may be linked to increased non-anastomotic intestinal perforation.
- Restricted surgical field with CUI, if not adequately extended, can lead to iatrogenic injury.
- Extend CUI without hesitation when surgical manipulation is difficult to prevent neonatal intestinal injury.
Abstract:
This study aimed to evaluate the safety and effectiveness of circumumbilical incision (CUI) for neonates requiring intestinal anastomosis. Seventy neonates requiring intestinal anastomosis at our institution between 2003 and 2020 were included in this retrospective case-control study. Patients were classified into the CUI (25 patients: 36%) and transverse incision (TI) groups (45 patients: 64%). Postoperative complications and surgical outcomes were compared between the two groups. Intestinal perforation at the non-anastomotic site occurred significantly more often in the CUI group than in the TI group (3 patients: 12%, and 0 patients: 0%, respectively (p = 0.042)). There were no between-group differences regarding anastomotic leakages, anastomotic strictures, time to enteral feeding, operative time, and blood loss. Neonatal intestinal surgery employing CUI might be associated with increased intestinal perforation at the non-anastomotic site. Hesitating to enlarge the skin incision to maintain favorable cosmetic outcomes might cause severe injury to the delicate neonatal intestine during the surgical procedure owing to the restricted surgical field. When performing CUI, we suggest that the skin incision should be extended without hesitation whenever there is difficulty in manipulating the intestine.
