J Korean Surg Soc.  2012 Dec;83(6):360-366. 10.4174/jkss.2012.83.6.360.

A comparison of the periumbilical incision and the intraumbilical incision in laparoscopic appendectomy

• Lee JS
• Hong TH
• Kim JG

• KMID: 1437531
• DOI: http://doi.org/10.4174/jkss.2012.83.6.360

Abstract

PURPOSE
The intraumbilical incision is being used more frequently, with increasing cases of single incision laparoscopic surgery. Since the umbilicus is deeper than the surrounding wall, it has abundant bacteria. No study has compared the adverse outcomes of periumbilical and intraumbilical incisions. We analyzed the wound complication rates of perforated appendicitis patients according to the types of umbilical incision.
METHODS
A retrospective review was done of 280 patients with perforated appendicitis. One hundred fifty nine patients were treated with the intraumbilical incision, and 121 patients were treated with the periumbilical incision. We compared the perioperative outcomes according to each laparoscopic incision.
RESULTS
There was no difference in operation time, postoperative hospital stay and analgesic requirement between the two groups. One case in the intraumbilical group (0.6%) and three cases in the periumbilical group (2.5%) developed wound infections. The umbilical complication rate showed no difference.
CONCLUSION
The wound complication rate of intraumbilical and periumbilical incisions are not different. Although this retrospective study has inherent limitations, the intraumbilical incision seems to be a safe and feasible alternative for the periumbilical incision that can be easier to perform, with better cosmetic results.

Keyword

Intraumbilical; Laparoscopic technique; Appendectomy

MeSH Terms

Appendectomy
Appendicitis
Bacteria
Cosmetics
Humans
Laparoscopy
Length of Stay
Retrospective Studies
Umbilicus
Wound Infection
Cosmetics

Figure

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  Fig. 1 The intraumbilical incision.

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  Fig. 2 A single full layer suture at the midpoint, with the needle pointing upward at both sides.

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  Fig. 3 A piece of balled-up gauze is placed, and an adhesive bandage is applied.

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  Fig. 4 Representative outcomes of the intraumbilical incision, 1 week after surgery (A) and the periumbilical incision (B).

Reference

1. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010. (10):CD001546.

2. Holder-Murray J, Zoccali M, Hurst RD, Umanskiy K, Rubin M, Fichera A. Totally laparoscopic total proctocolectomy: a safe alternative to open surgery in inflammatory bowel disease. Inflamm Bowel Dis. 2012. 18:863–868.

3. Pearce NW, Di Fabio F, Teng MJ, Syed S, Primrose JN, Abu Hilal M. Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg. 2011. 202:e52–e58.

4. Nguyen NT. Open vs. laparoscopic procedures in bariatric surgery. J Gastrointest Surg. 2004. 8:393–395.

5. Carbajo MA, Martin de lOlmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc. 1999. 13:250–252.

6. Azagra JS, Goergen M, Ansay J, De Simone P, Vanhaverbeek M, Devuyst L, et al. Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs open vertical banded gastroplasty. Surg Endosc. 1999. 13:555–558.

7. Zollinger RM, Ellison EC, Zollinger RM. Zollinger's atlas of surgical operations. 2011. 9th ed. New York: McGraw-Hill Medical.

8. Chow A, Purkayastha S, Nehme J, Darzi LA, Paraskeva P. Single incision laparoscopic surgery for appendicectomy: a retrospective comparative analysis. Surg Endosc. 2010. 24:2567–2574.

9. Kim HJ, Lee JI, Lee YS, Lee IK, Park JH, Lee SK, et al. Single-port transumbilical laparoscopic appendectomy: 43 consecutive cases. Surg Endosc. 2010. 24:2765–2769.

10. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A. 1999. 9:361–364.

11. Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc. 1998. 12:177–178.

12. Potter DD, Tung J, Faubion WA Jr, Moir C. Single-incision laparoscopic colon and rectal surgery for pediatric inflammatory bowel disease and polyposis syndromes. J Laparoendosc Adv Surg Tech A. 2012. 22:203–207.

13. Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis. 2008. 23:1013–1016.

14. Lee M, Kim SW, Nam EJ, Yim GW, Kim S, Kim YT. Single-port laparoscopic surgery is applicable to most gynecologic surgery: a single surgeon's experience. Surg Endosc. 2012. 26:1318–1324.

15. Belly Button Biodiversity [Internet]. c2012. cited 2012 Feb 27. [place unknown]: Belly Button Biodiversity;Available from: http://www.wildlifeofyourbody.org/.

16. Lemieur TP, Rodriguez JL, Jacobs DM, Bennett ME, West MA. Wound management in perforated appendicitis. Am Surg. 1999. 65:439–443.

17. Vidal O, Ginesta C, Valentini M, Marti J, Benarroch G, Garcia-Valdecasas JC. Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option. Surg Endosc. 2011. 25:1019–1023.

18. Lee SY, Lee HM, Hsieh CS, Chuang JH. Transumbilical laparoscopic appendectomy for acute appendicitis: a reliable one-port procedure. Surg Endosc. 2011. 25:1115–1120.

19. Iranmanesh P, Morel P, Inan I, Hagen M. Choosing the cosmetically superior laparoscopic access to the abdomen: the importance of the umbilicus. Surg Endosc. 2011. 25:2578–2585.

20. Kim HH, Ahn SH. The current status and future perspectives of laparoscopic surgery for gastric cancer. J Korean Surg Soc. 2011. 81:151–162.

21. Kwon IS, Yun SS, Lee DS, Kim HJ. Laparoscopic liver resection for malignant liver tumors, why not more? J Korean Surg Soc. 2012. 83:30–35.

22. Kwon SY, Jung JW, Kim BS, Kim TH, Yoo ES, Kwon TG. Laparoscopic versus open radical nephrectomy in T2 renal cell carcinoma: long-term oncologic outcomes. Korean J Urol. 2011. 52:474–478.

23. Park KK, Lee SH, Lee SH, Ahn BK, Baek SU. The learning curve by varied operative procedures in laparoscopic colorectal surgery. J Minim Invasive Surg. 2012. 15:44–49.

24. Huh JW, Kim HR. Laparoscopic total colectomy using left-to-right dissection: comparison with the conventional open approach. Surg Laparosc Endosc Percutan Tech. 2011. 21:94–97.