Three-flap umbilicoplasty: a novel and preliminary method of laparoendoscopic single-site transumbilical surgical approach for urachal remnants.

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.

Lip Repair Surgery for Bilateral Cleft Lip and Palate in a Patient Diagnosed with Trisomy 13 and Holoprosencephaly.

We report a case of lip repair surgery performed for bilateral cleft lip and palate in a patient diagnosed with trisomy 13 and holoprosencephaly. At the age of 2 years and 7 months, the surgery was performed using a modified De Hann design under general anesthesia. The operation was completed in 1 h and 21 min without large fluctuations in the child's general condition. The precise measurement of the intraoperative design was omitted, and the operation was completed using minimal skin sutures. It is possible to perform less-invasive and short surgical procedures after careful consideration during the preoperative planning. Considering the recent improvements in the life expectancy of patients with trisomy 13, we conclude that surgical treatments for non-life threatening malformations such as cleft lip and palate should be performed for such patients.

Cranial Reconstruction in a Pediatric Patient Using a Tissue Expander and Custom-made Hydroxyapatite Implant.

A tissue expansion technique in conjunction with a custom-made artificial bone implant was effective for a large cranial reconstruction in a pediatric patient. The patient was an eight-year-old boy with cranial bone fracture, acute subdural hematoma in the left lobe, and acute epidural hematoma in the right lobe due to an accident. Wound dehiscence and artificial dura infection were observed as postoperative complications. Because of insufficiency of the skin flap caused by scar contracture, a scalp skin expansion using a tissue expander was necessary before reconstruction with the artificial bone implant. This combined procedure provided safe coverage of the implant and resulted in good wound healing. There are relatively few reports involving the use of tissue expanders for cranioplasty; furthermore, our search of the literature did not reveal any reports involving children. We believe that this procedure is safe and effective for early rehabilitation in pediatric patients.