Novel Umbilicoplasty Technique Using Anterior Rectus Sheath Flaps for Pediatric Umbilical Hernias

The aim of this study is to present a new method for creating a deep umbilicus in pediatric umbilical hernias.

A retrospective chart review of patients who underwent umbilicoplasty using anterior rectus sheath flaps from 2010 to 2021 was conducted. Surgical technique: after performing an umbilical hernia repair through a cruciate incision within the umbilical fossa, umbilicoplasty was carried out. Anterior rectus sheath flaps measuring 7 × 20 mm were created 15 mm cranially and caudally from the umbilicus. These flaps were elevated, inverted, and threaded through two slits in the opposite anterior sheath, then sutured back into their original position. This procedure allowed the approximation of the bilateral anterior rectus sheaths. Finally, the cruciate incised skin was sutured at the base of the umbilicus. Measurements of the distance between the rectus muscles and the thickness of subcutaneous fat were taken using ultrasound preoperatively and at the final follow-up.

The study comprised 31 patients-14 males and 17 females-with a mean age at surgery of 4 years and an average follow-up duration of 13 months. In all cases, a deep umbilicus was successfully created and maintained. Ultrasound examinations revealed a reduction in the distance between the rectus muscles at five peri-umbilical points and an increase in subcutaneous fat thickness (p < 0.05).

The use of anterior rectus sheath flaps enabled the creation of a deep umbilicus that was sustainable over an extended period.