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Native Umbilical Defect for Laparoscopic Entry

Tarek Osama Hegazy,1 Mohamed Hassan Ali,1 Ahmed Amr Mohsen,2 Mahmoud Azhary,1 Ahmad Yahia Abdel Dayem,1

  1. Cairo University, Egypt

  2. National Research Centre, Cairo, Egypt

Correspondence to: Dr. Ahmad Yahia; email: dr_ahmadyahia@yahoo.com

Abstract

Background: The presence of defects in native umbilical in adults and its use as laparoscopic first entry site is poorly documented. It would likely be a safer method than the Veress needle and direct trocar insertion. This work aimed to report the prevalence and size of native umbilical defects, and their relationship with gender, age and body mass index. Methods: In 160 consecutive laparoscopic operations, a trans-umbilical incision was made and a defect at its base was looked for. When found, the defect was measured and used as the first port entry site. Relationships of presence of native defects and their sizes in relation to gender, age and BMI were analyzed. Results: The prevalence of a native defect in this series was 90%. Its presence had no relation with gender, age or BMI. Its size, however, positively correlated with age and BMI. No complications were related to the defect’s use for first laparoscopic entry site. Conclusion: A native umbilical defect is present in 90% of adults. Whenever present, it is recommended for use as the first port entry site by an open technique. This method is simple and safe and avoids unnecessarily inducing another defect.

Keywords: Laparoscopy, Open technique, Access, Native defect, Umbilical defect

Ann Afr Surg. 2020;17(3):116–119

DOI: http://dx.doi.org/10.4314/aas.v17i3.6

Conflicts of Interest: None

Funding: None

© 2020 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Submitted: 30 November 2019

Revised: 2 March 2020

Accepted: 29 March 2020

Online first: 29 May 2020

Introduction

At birth, the linea alba at the depth of the umbilicus has a defect. The linea alba is the passageway of umbilical vessels that connect the fetus with its placenta. The classic and long-held view is that this defect usually closes spontaneously within a week, but may take longer, up to two years; hence the dictum of not correcting an umbilical hernia before the age of two (1,2). This view was challenged by the finding of umbilical fascial defect in 25% of dissected adult cadavers (3).

It was further confronted by consistently finding even a small umbilical defect in all 94 pediatric patients ranging in age from 0.25 to 18 years, with a mean of 10 years, and by its practical use for laparoscopic entry (4). Furthermore, the same technique was later reported in 963 adult patients from Mexico, where it was found in 100% of cases who had no history of previous umbilical area surgery (5). While the use of Veress needle and direct trocar entry requires applying some force to penetrate the tough linea alba, open laparoscopy by Hasson’s technique, at least theoretically, reduces entry injuries. Furthermore, using an existing defect avoids unnecessarily adding another defect. Though the latter promises more safety and speed, it is rarely and inadequately mentioned in the medical literature, to the extent that it did not get a mention in a 2019 Cochrane systematic review about laparoscopic entry techniques (6).

This work studied the prevalence and size of native umbilical defect in adults, and how its existence and size relate with age, gender and body mass index (BMI). Another aim was to document its use as a laparoscopic first entry site.

 

Methods

This cohort study was conducted on 160 consecutive adult patients who had laparoscopic operations at the general surgery department of Cairo University Hospitals during May–August 2017. The study protocol was approved by KasrAlainy Research Ethics Committee and was archived using number