Quantification of Visceral Fat at the L5 Vertebral Body Level in Patients with Crohn's Disease Using T2-Weighted MRI.

The umbilical or L3 vertebral body level is often used for body fat quantification using computed tomography. To explore the feasibility of using clinically acquired pelvic magnetic resonance imaging (MRI) for visceral fat measurement, we examined the correlation of visceral fat parameters at the umbilical and L5 vertebral body levels. We retrospectively analyzed T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) MR axial images from Crohn's disease patients who underwent MRI enterography of the abdomen and pelvis over a three-year period. We determined the area/volume of subcutaneous and visceral fat from the umbilical and L5 levels and calculated the visceral fat ratio (VFR = visceral fat/subcutaneous fat) and visceral fat index (VFI = visceral fat/total fat). Statistical analyses involved correlation analysis between both levels, inter-rater analysis between two investigators, and inter-platform analysis between two image-analysis platforms. Correlational analysis of 32 patients yielded significant associations for VFI (r = 0.85; p < 0.0001) and VFR (r = 0.74; p < 0.0001). Intraclass coefficients for VFI and VFR were 0.846 and 0.875 (good agreement) between investigators and 0.831 and 0.728 (good and moderate agreement) between platforms. Our study suggests that the L5 level on clinically acquired pelvic MRIs may serve as a reference point for visceral fat quantification.

Surgical anatomy of transversus abdominis muscle for transversus abdominis release.

Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the medial margin of muscular part of transversus abdominis (TA) is of great importance. Hence, the authors sought to describe the extent of medial margin of TA muscle. The surgical steps of TAR were performed in 10 formalin-fixed cadavers and distance between medial margin of TA muscle, lateral margin of rectus abdominis, to linea alba at five anatomical levels were documented respectively. The distance between the inferior epigastric vessels and the medial border of TA muscle was also noted. The TA muscle was within the posterior rectus sheath in all cadavers, at the xiphisternum (R, 61.6 mm; L, 58.9 mm), and at midway between xiphisternum and umbilicus (R, 25.4 mm; L, 27.1 mm). The TA muscle exited the posterior rectus sheath between this point and the umbilicus. The mean incongruity at the next three levels were -24.6 mm, -24.9 mm, and -22.9 mm respectively on the right and -21.4 mm, -19.9 mm, and -18.9 mm respectively on the left. The mean distance between the medial border of TA and inferior epigastric vessels was 18.9 mm on the right and 17.2 mm on the left. The muscular part of TA was incorporated within the posterior rectus sheath above the umbilicus, and it completely exited the rectus sheath at the umbilicus. This is contrary to the traditional understanding of posterior rectus sheath formation.

Diagnosis and management of placentitis with severe funisitis in a multiparous Warmblood mare.

Placentitis is an important cause of reproductive losses in the equine industry. Many cases of clinical placentitis are not diagnosed until late in the course of the disease, and for this reason there is variability in the timing of intervention, diagnostic measurements, and treatment protocols. An 8-year-old multiparous Dutch Warmblood mare that was recently exposed to EHV-1 in the herd of origin presented for routine foaling management. Placentitis was diagnosed upon intake, and medical treatment was initiated. The mare delivered a term foal, and diagnostics for infectious etiology were unrewarding. While there were obvious clinical signs supporting a diagnosis of placentitis, histopathologic examination did not reveal active inflammatory lesions in the chorioallantois; however, severe funisitis was present. This report reviews early diagnosis and management of placentitis, demonstrates an array of classic and subtle pathologic lesions seen on microscopic examination, and discusses pathophysiology of placentitis.

The Preservation of Umbilical Blood Supply in Combined Ventral Hernia Repair and Abdominoplasty: A Narrative Review.

INTRODUCTION: Combined ventral hernia repair and abdominoplasty treat risk factors such as high body mass index and weak abdominal musculature, providing excellent intraoperative exposure and improved patient outcomes. Unfortunately, a combination of traditional procedures is unfeasible as the umbilical blood supply would be compromised, leading to increased umbilical necrosis risk. This narrative review aimed to identify new techniques and solidify evidence in preserving umbilical blood supply and associated level of evidence. METHODS: Two authors conducted a thorough literature search on PubMed, Scopus and Cochrane CENTRAL databases from January 1901 to July 2023, adhering to the methodologies of the preferred reporting items for systematic reviews and meta-analyses. Studies were reviewed for their surgical technique and quality of evidence. The primary outcomes of interest consisted of umbilical complications of this combined procedure. RESULTS: Six techniques were identified that included laparoscopic, pre-rectus, unilateral, distal bilateral, proximal bilateral, and inferior midline approaches. All techniques demonstrated as viable options in preserving umbilical blood supply as reported complications were few, minor, and compounded by risk factors. However, all included techniques were limited to low-to-moderate-quality evidence. CONCLUSION: Despite the lack of high-quality evidence, all techniques remain viable options for combined ventral hernia repair and abdominoplasty. Large-scale high-quality RCTs are required to compare the effectiveness of various approaches with additional outcomes of hernia recurrence rates, intraoperative time, and patient- and surgeon-reported satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dermoscopy of Umbilical Lesions-A Systematic Review.

Background: The umbilicus is a fibrous remnant located in the centre of the abdomen. Various entities may be encountered in this special anatomical location; however, little is known about their dermoscopic presentation. The aim of this study was to provide a comprehensive summary of existing evidence on dermoscopic features of umbilical lesions. Methods: Studies assessing dermoscopic images of umbilical lesions were included in this study. No age, ethnicity or skin phototype restrictions were applied. Papers assessing lesions outside of the umbilical area, lacking dermoscopic images and/or dermoscopic description and not related to the topic were excluded. Embase, Medline and Cochrane Library were searched from inception to the end of May 2023. The Joanna Briggs Institute critical appraisal tools were used to evaluate the risk of bias of the selected studies. The quality and the level of evidence of included studies were assessed according to the Oxford 2011 Levels of Evidence. Thirty-four studies reporting a total of 39 lesions met the inclusion criteria and were included in qualitative analysis. Results: A qualitative synthesis of the following entities was performed: melanoma, nevi, basal cell carcinoma, fibroepithelioma of Pinkus, Sister Mary Joseph nodule, mycosis fungoides, dermatofibroma, endometriosis, epidermal cyst, granuloma, intravascular papillary endothelial hyperplasia, lichen planus, omphalolith, seborrheic keratosis, and syringoma. Conclusions: Dermoscopy is a non-invasive technique that may be useful in the differential diagnosis of umbilical lesions. The main limitations of this study were lack of a high level of evidence in the studies and the lack of uniformity in applied dermoscopic terminology between included studies.

Alternativas para onfaloplastia em cirurgia estética do abdome: Revisão da Revista Brasileira de Cirurgia Plástica e apresentação da experiência com técnica em H / Alternatives to omphaloplasty in aesthetic surgery of the abdomen: Review of the Revista Brasileira de Cirurgia Plástica and presentation of the experience with the technique in H

Introdução: A abdominoplastia está entre os procedimentos estéticos mais procurados na cirurgia plástica nos últimos anos. Dentro da perspectiva da imagem corporal, a confecção do neoumbigo é peça chave, e sua ausência, distorção ou má cicatrização comprometem o resultado cirúrgico. Diversas técnicas foram descritas, mas todas com suas limitações. O objetivo foi reunir um resumo das possibilidades cirúrgicas apresentadas na Revista Brasileira de Cirurgia Plástica (RBCP), além de reapresentar a técnica em H. Método: Foi realizada revisão qualitativa da literatura publicada na RBCP no período de 2000 a 2021. Foram incluídos artigos que descrevessem uma proposta de umbilicoplastia, referindo número de pacientes, idade, tempo de seguimento, avaliação da satisfação dos pacientes e complicações; sendo excluídas publicações sem fins estéticos ou pacientes pós grandes perdas ponderais. Resultados: Foram encontrados 38 artigos, sendo excluídos 7 pela análise dos títulos e resumos. Os demais artigos foram revisados por dois autores independentes, sendo realizada a exclusão de mais 20 artigos. No final, 11 artigos foram incluídos nesta revisão. Conclusão: A onfaloplastia em abdominoplastias pode ser realizada de várias formas, possibilitando uma gama variável de alternativas para os cirurgiões. A técnica em H é mais uma dessas ferramentas, podendo ser amplamente utilizada e trazendo resultados consistentes.

Introduction: Abdominoplasty has been among the most popular cosmetic procedures in plastic surgery in recent years. From the perspective of body image, making the new navel is a key part, and its absence, distortion, or poor healing compromises the surgical result. Several techniques have been described, but all with their limitations. The objective was to gather a summary of the surgical possibilities presented in the na Revista Brasileira de Cirurgia Plástica (RBCP), in addition to reintroducing the technique in H. Method: A qualitative review of the literature published in the RBCP in the period from 2000 to 2021 was carried out. Articles were included that described a proposal for umbilicoplasty, referring to the number of patients, age, follow-up time, assessment of patient satisfaction, and complications, excluding publications without aesthetic purposes or patients after major weight loss. Results: 38 articles were found, 7 of which were excluded by analyzing the titles and abstracts. Two independent authors reviewed the other articles, excluding another 20. In the end, 11 articles were included in this review. Conclusion: Omphaloplasty in abdominoplasties can be performed in several ways, providing surgeons with various alternatives. The H technique is one of these tools which can be widely used and bring consistent results.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g?

BACKGROUND: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. METHODS: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. RESULTS: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). CONCLUSIONS: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

INTRODUCCIÓN: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. MÉTODOS: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. RESULTADOS: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. CONCLUSIONES: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Umbilical seborrheic keratosis-like lesion developing after diode laser hair removal in an 18-year-old patient.

OBJECTIVE: to report a possibly novel complication of laser hair removal. CASE REPORT: a white-skinned 18-year-old patient discovered an umbilical, brown, and raised lesion while shaving before his second diode laser hair removal session. He sought consultation before his fourth laser session since the lesion further thickened and darkened. Dermoscopy showed no pigmented network, but a few comedo-like openings within an erythematous-light brown scaly and fissured papule, "moth-eaten" borders, and a central crust due to manipulation, suggesting the diagnosis of seborrheic keratosis. We noted that the laser fluence was increased on the umbilical region where hair seemed resistant to treatment. The patient denied a recent history of local sun tanning, sunburns, inflammation, drainage, or manipulation. The lesion cleared, with no short-term relapse, after one session of cryotherapy. CONCLUSION: the development of a seborrheic keratosis-like lesion on a densely haired non-sun-exposed umbilicus of a young patient, following pre-laser shaving and high-fluence hair removal diode laser sessions, could have implicated triggering irritation and/or keratinocyte stimulation by red light-engendered reactive oxygen species (ROS) in the skin with silent epidermal mosaicism.

Microbiota in Umbilical Dirt and Its Relationship with Odor.

The umbilicus accumulates more dirt than other body surfaces and is difficult to clean. Hygiene in this area is vital, particularly for surgery, because of its proximity to the laparotomy site. Although microorganisms in the umbilicus have been extensively examined, those in umbilical dirt have not due to the lack of an efficient method of collection. We previously established a technique to extract umbilical dirt using the anchor effect of polymers, which are injected into the umbilicus. In the present study, we applied this technique for the first time to investigate umbilical dirt. The results obtained revealed an abundance of Corynebacterium among various bacteria, whereas Cutibacterium and Staphylococcus, which are abundant at other skin sites, were rare. The relationships between the microbiota and issues related to the umbilicus were investigated and some covariates, including the odor score and several bacteria, were identified. A detailed ana-lysis of the genera associated with odor revealed no correlation with Corynebacterium; however, some minor anaerobic bacteria, such as Mobiluncus, Arcanobacterium, and Peptoniphilus, were more abundant in the high odor score group. Therefore, this technique to collect umbilical dirt provided insights into the microbiota in umbilical dirt and suggested functions for minor anaerobes. Furthermore, since various pathogenic microorganisms were detected, their control may contribute to the prevention of both odor production and infectious diseases caused by these microorganisms.

Laparoscopic Excision of a Symptomatic Urachal Cyst (UC) in an Adult.

Urachal cysts (UCs) are rare congenital anomalies, especially in adults. They often mimic a variety of intra-abdominal pathologies, making the diagnosis difficult. Laparotomy and excision of the cyst along with the umbilicus has been the traditional technique. A 33-year-old female presented with painful umbilical swelling. A CT scan was suggestive of a UC. We performed an umbilicus-preserving laparoscopic excision of the cyst. We describe this rare case and review literature related to the surgical treatment of UCs.

Incarcerated Richter's congenital umbilical hernia in a young male: A case report.

INTRODUCTION AND IMPORTANCE: Richter's hernia is a protrusion of a portion of the circumference of anti-mesenteric side of intestine through the fascial defect. It is a rare type of hernia and typically occurs in elderly patients. Richter's hernia could result in grave complications. The objective of the study was to describe a rare case of incarcerated Richter's congenital umbilical hernia in a 20-year-old male patient. CASE PRESENTATION: A 20-year-old male presented with a complaint of intermittent crampy peri-umbilical pain of three days duration associated with non-reducible umbilical bulge and vomiting. On examination, there was 4 cm by 4 cm oval, firm, tender, non-reducible mass over the umbilical area without cough impulse. He was kept nothing per os, broad spectrum antibiotic started, consent taken & operated. A loop of the ilium which was mildly ischemic found in the hernia sac. Sac and entrapped intestine were thoroughly cleaned with warm saline and reduction and herniorrhaphy done. The client discharged on the 2nd postoperative day. CLINICAL DISCUSSION: There have been very few reports of Richter's congenital umbilical hernia. Richter's hernia progresses more rapidly to gangrene than other strangulated hernias however patients often have no intestinal obstruction. Raised suspicion therefore is important to take timely surgical intervention before the disease advance and complications occurred. CONCLUSION: Richter's hernia has subclinical symptoms and late presentation which could result in grave complications and increased mortality. The early decision for surgery has paramount importance in reducing complication and associated mortality.

Does Size Really Matter? A Review on How to Determine the Optimal Umbilical Size During an Abdominoplasty.

Background: The umbilicus has historical significance regarding health and beauty principles. The visually pleasing aesthetic of the umbilicus has become a vital standard for the perceived success of an abdominoplasty procedure. While the ideal position and shape of the umbilicus have been studied extensively in literature, less is known about the optimal size. Herein, the authors provide a comprehensive literature review to help determine the ideal umbilical size. Methods: A computerized search in the PubMed database was performed to identify articles that discussed ideal umbilical size. Results: The review was performed in July 2022. A total of 21 articles were initially identified, only 6 of which discussed umbilical size. References from the included articles were also evaluated for relevance and resulted in 10 additional articles in the final review. Most of the articles indicated that a smaller umbilicus was found to be aesthetically pleasing, but a numerical range of values were not specified. Conclusions: Although the literature on the ideal umbilical size is sparse, the consensus is toward a smaller, vertically oriented umbilicus.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g? / Comparación entre las fórmulas de Wright y de Shukla: ¿cuál es mejor para la colocación de catéteres umbilicales en recién nacidos ≤ 1500 g?

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Necrotizing fasciitis following rapidly deteriorating neonatal omphalitis with good initial presentation.

Neonatal omphalitis is a postpartum infection of periumbilical superficial soft tissues that usually has a good prognosis in developed countries. In rare cases, it could progress to periumbilical necrotizing fasciitis (NF), which is an infection of the deep soft tissues, including muscle fascia, and has a high mortality rate. However, the signs and timing of developing NF secondary to omphalitis are unclear. We encountered a neonatal case of NF following omphalitis. In the initial days of the clinical course, general symptoms and condition of the patient were good, and abdominal physical findings were mild; however, the patient rapidly developed NF. The patient was successfully treated by emergent surgical debridement, broad-spectrum antibiotics, and intensive care. To determine the area of blood perfusion, we intravenously injected indocyanine green by intraoperative angiography, and then extensively removed necrotic and hypoperfused tissues. In neonatal omphalitis, the deterioration can suddenly occur despite good initial conditions; intensive monitoring should be required during the first few days of the clinical course.

Endometriosis of the umbilicus in a 36-year-old woman: a case report and literature review.

Extrapelvic endometriosis is quite rare, with a reported prevalence ranging between 0.5 and 1%, and the condition is more likely to pose diagnostic challenges. This condition is more likely to pose clinical diagnostic challenges as it may mimic metastasis such as Sister Mary Joseph's nodule. Case presentation: Herein is reported the case of a 36-year-old woman who presented with a hard nodular dark-bluish umbilicus mass that had a tendency to increase in size and was accompanied by severe pain during menstruation for ∼2 years is reported. Laparotomy revealed a normal uterus without involvement of any other pelvic organ by the endometrial tissue except the umbilicus part. Histological evaluation revealed endometriosis of the umbilicus. Clinical discussion: By far, primary endometriosis of the umbilicus is extremely rare, and most of the time, extrapelvic endometriosis involving the umbilicus would be secondary to surgical procedures involving the abdominal cavity as it was for the presented patient. Although endometriosis is rare, it should always be considered among women of reproductive age presenting with cyclic pains. Conclusions: Meticulous investigation of patients suspected to have umbilical endometriosis helps to confirm the diagnosis and hence expedites proper management of the patients; this also prevents chances of malignant transformation of the condition despite such possibilities being extremely rare.

Transperitoneal laparoscopic umbilical resection of urachal remnants: a feasible surgical method.

BACKGROUND: To date, there is no standard established laparoscopic surgical method for managing urachal remnants because of their rarity, and several questions remain unanswered. Are there any problems for considering the operative indications about patients' factors for example, body mass index and so on? This study aimed to determine the feasible surgical method for managing urachal remnants and presents the operative outcomes of our cases in relation to the findings from the existing literature. METHODS: We analyzed the data of 16 patients (7 women and 9 men; age range, 19-48 years) who underwent surgery for urachal remnants between January 2013 and March 2019 at our institution. RESULTS: In our cases, all urachal remnants were urachal sinuses, and the primary complaints were umbilical pain and pus discharge. Most of these symptoms were controlled using umbilical drainage and oral antibiotic intake; however, incisional drainage was required in two cases. In all cases, we performed a laparoscopic resection of the urachal remnants; one patient underwent an open conversion due to a very thick abdominal wall. Therefore, "peri-umbilical distanse" was proposed as an index to verify the periumbilical abdominal wall thickness. This index may clear the difficulties of the laparoscopic resection of the urachal remnunts. A postoperative complication-local infection that was treated using re-suturing-was observed in one patient. No adverse events occurred in the other cases. Our method was appropriate because it allowed for complete urachal resection with good cosmetic results, i.e., a small and natural scar appearance. Additionally, if bladder injury occurred, bladder re-suturing was easily possible because of the laparoscopic port's position. CONCLUSIONS: We present an feasible method for laparoscopic urachal resection. This method may be recommended for young patients with an peri-umbilical distanse of < 2 cm.

Non-operative management of umbilical pilonidal sinus: One more step towards ideal therapy.

There are controversies regarding the management of umbilical pilonidal sinuses. The current study aims to report on the efficacy of a non-operative, umbilical conserving procedure in the treatment of umbilical pilonidal sinus. This is a prospective, single cohort study. The cases were managed in a single private practice center. Patients were assessed and managed throughout the previous nine years (from January 2013 to June 2022). The required information was obtained from the center's medical database. The current study included 114 patients. There were 82 (71.9%) male patients. The patients' ages varied from 14 to 56 years (mean = 23.24). The umbilicus was retracted under local anesthesia. The sinuses were cleaned with povidone-iodine. Following the drying of the cavity, the mixture was put in the umbilicus, and the area was dressed. The amount of mixture was determined by the size of the cavity. Following treatment, the patients were directly discharged home with instructions to remove all hair from the chest and abdomen and keep the dressing dry for three days. After three days, the patients were advised to use a clean cotton swab to remove the injected mixture. Recurrence was reported in 5 cases (4.4%). The current technique might be used effectively in the treatment of umbilical pilonidal sinus. It is an umbilical preserving technique with a minimal recurrence rate.

Laparoscopic procedures-induced keloids: A retrospective case series study.

The abdominal skin is not a common area for keloid formation. The knowledge of laparoscopically induced keloids (LIK) remains little. This article aimed to review the case series of LIK and analyse the characteristics. A retrospective and descriptive study was conducted. Patients' clinical records in the database were collected, including the demographics, medical history, laparoscopic surgery information, keloid information, and the severity of LIKs recorded using the Patient and Observer Scar Assessment Scale. Twenty-four LIK patients were enrolled. 18 patients were female and 10 had chronic diseases. 11 patients had non-LIKs. 91.6% patients received laparoscopic cholecystectomy. LIKs were mainly located under the xiphoid process (N = 20), followed by the umbilicus (N = 16). 41.7% patients developed keloids at all trocha sites. The severity of the LIK was significantly negatively associated with the presence of the non-LIK. Laparoscopic procedures could lead to the formation of keloids. Two types of LIKs were noticed: extended incisions induced long "spreading" type and trocha induced round bulging type. The presence of non-LIKs could significantly reduce the severity of LIKs.

Management of Hidden Cutaneous Melanoma of the Umbilicus.

Melanoma is currently the fifth most common cancer in the United States (US) and most often develop on areas that have increased sun exposure, such as the arms, legs, back or face. The incidence of primary cutaneous melanoma increases each year and curative treatment improves with earlier detection of disease. Primary cutaneous umbilical melanoma is extremely rare with as few as 46 cases reported worldwide. As a result, limited literature is available regarding the management of tumors originating in the umbilicus. By evaluating uncommon areas such as the umbilicus, earlier detection and possible intervention can be provided. We present a rare case of a 33-year-old female with a primary cutaneous melanoma of the umbilicus successfully treated with wide local excision (WLE) and sentinel lymph node biopsy (SLNB).