Can the modified Tan–Bianchi circumumbilical approach be used for treating older children?

Abstract

Background and aim Since Tan and Bianchi reported umbilical incision as an access for pyloromyotomy in infantile hypertrophic pyloric stenosis, many pediatric surgeons have used this approach for a number of other procedures. Most of these studies focused on the usefulness of such an approach in neonates. This study aims at assessing the usefulness of the circumumbilical approach for exploring the abdominal cavity of infants and older children for treating a variety of surgical intra-abdominal diseases to achieve minimally invasive surgery with excellent cosmetic results.
Patients and methods All patients who underwent a circumumbilical skin incision for an exploratory laparotomy during the period June 2009 to October 2010 were reviewed. Age, operative procedure, conversions to standard laparotomy, complications, and follow-up data were recorded.
Results A total of 27 infants and children with ages ranging from 3 months to 8 years underwent circumumbilical incision for abdominal exploration. The indications were as follows: nonrotational malrotation of the midgut (n= 2), intussusception (n= 13), complicated V–P shunts (n = 4), acute abdomen that proved to be due to Meckel’s diverticulitis (n= 2), gastrotomy for removal of an impacted foreign body from the stomach (n= 1), pyloroplasty for caustic injury of the pylorus (n =1), lymphatic mesenteric cyst (n =1), and complicated appendicitis (n= 3). Conversion to a standard midline incision was necessary in one case. The complications encountered included wound infection (n =5), burst abdomen (n= 1), and incisional hernia (n= 2). Subsequent follow-up revealed that all incisions had healed and the scars were almost imperceptible as affirmed by parental satisfaction during outpatient clinic consultation.
Conclusion The circumumbilical approach appears to be safe, flexible, and easily reproducible, providing adequate exposure for some abdominal surgeries even in older infants and children as it has been tried successfully in neonates. The low-complication rate and pleasing aesthetic outcome are well-appreciated by parents and operators alike.

Keywords: children, circumumbilical approach, laparotomy