Abstract
Purpose
Symptomatic urachal remnants are rare benign anomalies affecting young adults. For these patients, both curative treatment and acceptable postoperative aesthetic outcomes are important. Here, we describe a novel transumbilical approach, using Y-shaped incisions and three-flap umbilicoplasty techniques, to improve repair and aesthetic outcomes.
Materials and methods
The clinical and perioperative data of 16 patients (11 men; median age, 25 years; range 16–46 years) who underwent LESS surgery and three-flap umbilicoplasty (LESS group) between December 2013 and March 2017 were analyzed. For comparison, the perioperative data of those who underwent conventional laparoscopic surgery (CL group) between May 2010 and November 2013 at the same institutions were investigated.
Results
The median operative time of the LESS group was longer than that of the CL group (146.5 vs 107 min; p = 0.009). The estimated blood loss and postoperative hospital stay were not significantly different between the two groups. The two perioperative complications were injury to the transverse colon serosa and minor surgical site infection. Both complications were resolved with appropriate management.
Conclusions
This novel umbilical approach is useful for patients with symptomatic urachal remnants, with the reduction in port-site scarring resulting in good postoperative cosmesis.
Similar content being viewed by others
References
Berman SM, Tolia BM, Laor E, Reid RE, Schweizerhof SP, Freed SZ (1988) Urachal remnants in adults. Urology 31(1):17–21
Begg RC (1930) The urachus: its anatomy, histology and development. J Anat 64(Pt 2):170–183
Blichert-Toft M, Nielsen OV (1971) Diseases of the urachus simulating intra-abdominal disorders. Am J Surg 122(1):123–128
Neufang T, Ludtke F, Lepsien G (1992) Laparoscopic excision of an urachal fistula—a new therapy for a rare disorder. Minim Invasive Ther Allied Technol 1(3):245–249
Patrzyk M, Glitsch A, Schreiber A, von Bernstorff W, Heidecke CD (2010) Single-incision laparoscopic surgery as an option for the laparoscopic resection of an urachal fistula: first description of the surgical technique. Surg Endosc 24(9):2339–2342. doi:10.1007/s00464-010-0922-4
Iida T, Kawa G, Takizawa N, Kawabata T, Komai Y, Kinoshita H, Matsuda T (2012) Laparoendoscopic single-site surgery for urachal remnants. Asian J Endosc Surg 5(2):100–102. doi:10.1111/j.1758-5910.2011.00126.x
Sato F, Shin T, Yuki H, Liang M, Ando T, Mori K, Nomura T, Mimata H (2012) Umbilical laparoendoscopic single-site technique for complete excision of urachal remnant. J Laparoendosc Adv Surg Tech A 22(9):899–903. doi:10.1089/lap.2012.0245
Kaneko K, Tsuda M (2004) Four-triangular-skin-flap approach to umbilical diseases and laparoscopic umbilical port. J Pediatr Surg 39(9):1404–1407
Takasu H, Watanabe Y (2010) Umbilicoplasty with 3 triangular skin flaps and excised diamond-shaped skin flap. J Pediatr Surg 45(10):2041–2044
Lesavoy MA, Fan K, Guenther DA, Herrera F, Little JW (2012) The inverted-v chevron umbilicoplasty for breast reconstruction and abdominoplasty. Aesthet Surg J 32(1):110–116
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Araki M, Saika T, Araki D, Kobayashi Y, Uehara S, Watanabe T, Yamada K, Nasu Y, Kumon H (2012) Laparoscopic management of complicated urachal remnants in adults. World J Urol 30(5):647–650. doi:10.1007/s00345-012-0829-x
Jeong HJ, Han DY, Kwon WA (2013) Laparoscopic management of complicated urachal remnants. Chonnam Med J 49(1):43–47. doi:10.4068/cmj.2013.49.1.43
Li Destri G, Schillaci D, Latino R, Castaing M, Scilletta B, Cataldo AD (2011) The urachal pathology with umbilical manifestation: overview of laparoscopic technique. J Laparoendosc Adv Surg Tech A 21(9):809–814. doi:10.1089/lap.2011.0155
Patrzyk M, Wilhelm L, Ludwig K, Heidecke CD, von Bernstorff W (2013) Improved laparoscopic treatment of symptomatic urachal anomalies. World J Urol 31(6):1475–1481. doi:10.1007/s00345-013-1039-x
Siow SL, Mahendran HA, Hardin M (2015) Laparoscopic management of symptomatic urachal remnants in adulthood. Asian J Surg 38(2):85–90. doi:10.1016/j.asjsur.2014.04.009
Hong SH, Kim JC, Hwang TK (2007) Laparoscopic partial cystectomy with en bloc resection of the urachus for urachal adenocarcinoma. Int J Urol 14(10):963–965. doi:10.1111/j.1442-2042.2007.01855.x
Yanishi M, Kinoshita H, Mishima T, Taniguchi H, Yoshida K, Komai Y, Yasuda K, Watanabe M, Sugi M, Matsuda T (2017) Influence of scars on body image consciousness with respect to gender following laparoendoscopic single-site versus conventional laparoscopic surgery. Scand J Urol 51(1):57–61. doi:10.1080/21681805.2016.1250811
Cutting CW, Hindley RG, Poulsen J (2005) Laparoscopic management of complicated urachal remnants. BJU Int 96(9):1417–1421. doi:10.1111/j.1464-410X.2005.05856.x
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Kim, H., Nakajima, S., Kawamura, Y. et al. Three-flap umbilicoplasty: a novel and preliminary method of laparoendoscopic single-site transumbilical surgical approach for urachal remnants. Int Urol Nephrol 49, 1965–1971 (2017). https://doi.org/10.1007/s11255-017-1678-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-017-1678-8