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Background This study aimed to determine the typical position and shape of the umbilicus among young individuals to guide the repositioning of the new umbilicus during abdominoplasty. Methods Standardized photographs of 63 young volunteers were analyzed to evaluate parameters such as the vertical and horizontal positions, length, ratio, and shape of the umbilicus. The study also established the mathematical relationships between the umbilicus and nearby anatomical structures like the xiphoid process, pubic symphysis, anterior superior iliac spine, iliac crests, and body mass index (BMI) to identify the ideal geometric shapes and positions. In two patients with abdominal skin sagging, abdominoplasty was performed with a new umbilicus designed according to these anatomical measurements. Results The umbilici were categorized by shape: vertical oval with superior hooding (29%), round (27%), vertical lozenge (21%), and protruded (11%). Ratios between anatomical points were measured, such as the ratio of the distance between the xiphoid process and the upper edge of the umbilicus to the distance between the lower edge of the umbilicus and the symphysis pubis, which was 1.64 ± 0.40. Post-operative evaluation emphasized achieving a xiphoid-umbilicus/pubic symphysis ratio of 1.6:1 for the new umbilicus, with an aesthetically ideal ratio considered to be 1:1. A strong correlation was found between BMI and all umbilical ratios. Conclusions The most aesthetically pleasing navel position aligns with the golden ratio between xiphoid and umbilicus compared to the umbilicus and abdominal crease. Weight control is also crucial in achieving optimal belly aesthetics.

Purpose To radiographically assess the umbilicus’ level (i.e. latitude) relative to the anterior lumbar spine based on varying pelvic incidence (PI) magnitudes. Methods Pediatric patients (ages 10–18 years) with a previously obtained CT abdomen/pelvis were reviewed. Excluded were patients with prior spine surgery, spinal deformity, and/or underlying lumbar spinal degenerative pathology. On sagittal CT images, 2 radiologists recorded the vertebral level/disc space that corresponded to the umbilicus’ latitude level. On the CTs’ scout lateral images, two spine surgeons measured the PI. The spinal level corresponding to the umbilicus’ latitude was compared between 3 groups based on PI magnitude: low (< 45°), middle (45°-65°), and high (65°). Results 107 patients (average age = 14.82.0 years; 62.6% female; average BMI=25.9±10.1) met inclusion criteria. Of all patients, the umbilicus’ level ranged from the L3-4 disc to the L5 vertebral body with the L4-5 disc (36.4%) and L4 vertebral body (29.0%) being the most common levels. Average PI was 47.2 ° 11.9 ° (Low PI–41.1%; Middle PI–46.7%; High PI–12.1%). The umbilicus’ level relative to the spine significantly varied based on PI magnitude ( p <0.001). In Low PI, the majority’s umbilicus corresponded to the L4-5 disc (50%) or L5 vertebral body (18.2%). In Middle PI, the majority’s umbilicus was at the L4 vertebral body (34.0%) and L4-5 disc (34.0%). In High PI, the majority’s umbilicus corresponded to the L3-4 disc (38.5%) or L4 vertebral body (46.2%). Conclusions The umbilicus’ level relative to the lumbar spine significantly varies based on PI magnitude. Patients with lower PIs (low sacral slope) have their umbilicus more commonly located over the distal lumbar spine (L4-5 disc/L5 vertebral body), while high PI patients (high sacral slope) have more superiorly located vertebral levels when referencing the umbilicus. Additional clinical investigations will be beneficial to confirm utility of these findings in guiding location of ALIF incisions.

Background Laparoscopic cholecystectomy is the standard treatment for gallstone disease offering advantages such as minimal incision size and rapid recovery. The study compares the surgical site infection (SSI) rates between transumbilical (TUI) and periumbilical incisions (PUI) in this method. Methods A randomized controlled trial was conducted from December 2021 to December 2023 at Panyananthaphikkhu Chonprathan Medical Center, Thailand. Patients undergoing laparoscopic cholecystectomy were randomly assigned to TUI or PUI groups. The primary endpoint was SSI rate, with secondary endpoints including length of hospital stay, operative time, blood loss, conversion rate, complications, cosmetic satisfaction, pain score, wound hypersensitivity, and numbness. Results A total of 156 patients were enrolled, with 78 patients in each group. The incidence of SSI was 14.1% in the TUI group and 10.3% in the PUI group ( p  = 0.46). There were no conversions to open surgery, bile leaks, intra-abdominal infections, reoperations, or mortalities observed in either group. Outcomes related to cosmetic satisfaction, wound numbness, and wound hypersensitivity were comparable between the groups. Patients who developed SSI demonstrated lower cosmetic satisfaction scores on postoperative day 7 surgery (8.47 ± 1.3) compared to those without SSI (9.5 ± 0.8) ( p  < 0.001), although these scores were similar by day 30. Additionally, the SSI group exhibited a higher prevalence of umbilical wound hypersensitivity on day 30 post-surgery [11 (57.9%) vs. 35 (25.7%), p  = 0.04]. Conclusions SSI rates and other surgical outcomes were comparable between TUI and PUI in laparoscopic cholecystectomy, encouraging the use of either technique based on surgeon preference and patient-specific factors.

This is a retrospective clinical study that summarizes the clinical experience of single-port laparoscopic medial umbilical fold reinforcement surgery (SPLMUFRS) for pediatric giant inguinal hernia with the internal ring diameter greater than 1.5 centimeters. 147 children with inguinal hernia admitted to the Department of Pediatric Surgery, Qilu Hospital of Shandong University (Qingdao) from July 2019 to June 2023 were included in this study, including 124 males and 23 females. All patients were divided into Group A ( n  = 86) and Group B ( n  = 61) based on the last digit of their hospitalization number, with odd numbers included in Group A and even in Group B. Both groups underwent single-port laparoscopy, but the surgical methods were different. The primary outcome was the postoperative recurrence rate, and secondary outcomes were the percentage of metachronous indirect inguinal hernia (MCIH), surgical time, and pain score at hernia needle puncture site. The average age of Group A was 61.5 ± 23.8 (13–148) months, and the average weight was 22 (18–27) Kg. The average age of Group B was 57.7 ± 27.2 (17–159) months, and the average weight was 22 (19–27) Kg. There was no statistically significant difference in age and weight between the two groups. During the laparoscopy, a total of 147 unclosed internal rings were found that had a diameter greater than 1.5 cm (86 in Group A and 61 in Group B), and they were treated with SPLMUFRS after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC), with Group A underwent V-shaped fixation method and Group B underwent U-shaped fixation method. The average surgical time for Group A was 11.8 ± 1.9 (9–16) minutes, while Group B was 13.8 ± 2.6 (9–20) minutes, and the difference in surgical time between the two groups was statistically significant ( P <0.001). All patients underwent surgery smoothly. All patients were followed up for 1–3 years after surgery, and no patients experienced postoperative recurrence. Several patients experienced short-term pain at the puncture site or temporary hydrocele, which improved significantly after conservative observation. Although there are differences in the surgical methods and surgical time between the two types of SPLMUFRS, they are safe and reliable for pediatric giant inguinal hernia with the internal ring diameter greater than 1.5 cm, and can reduce the postoperative recurrence rate.

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 .

Umbilical endometriosis (UE) is a rare condition. We have documented the clinical characteristics, management strategies, and follow-up results for five cases treated at our hospital between 1998 and 2020, with patients aged between 31 and 44 years. Patients typically presented with umbilical swelling. In all cases, surgical removal was effective and no complications were reported. Two patients had concurrent ovarian endometriosis and one adenomyosis. No umbilical recurrence was recorded during follow-up. We believe that these findings offer valuable insights for the management of this patient population. Clinical management strategies for this disease should be tailored to each patient and carried out collaboratively by both general and gynaecological physicians.

No Level Assigned  This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

To enhance the current clinical understanding and improve the diagnosis and treatment of Actinotignum schaalii infections, we have presented here a report of the case of recurrent infections at a periumbilical scar, induced by Actinotignum schaalii and complicated by abscess formation in a 50-year-old woman with persistent festering at the site of a periumbilical scar after laparoscopy 9 years ago, with subsequent ruptures over the past 2 years. Physical examination revealed a radial fold scar with localized redness and slight swelling of the skin below the navel. Although no significant increase in the local skin temperature was noted, tenderness was present. A rupture at the site was also observed, and gentle compression produced a small amount of odorless and yellowish viscous pus. Anerobic culturing of the pus for 3 days revealed gray-white, non-hemolytic, spore-free, gram-positive, slightly curved rod-shaped bacteria. These bacteria were identified as A. schaalii using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The patient was subsequently treated with a 1-month course of oral amoxicillin, combined with debridement and drainage. Her condition improved with regular dressing changes. However, during follow-up 6-month later, the patient presented with a recurrence of the local infection at the scar site, again accompanied by abscess formation and rupture. Notably, the wound size was smaller, and after a 1-week treatment with silver ion, without any systemic antibiotic administration, her condition improved. Next, triamcinolone acetonide combined with lidocaine was injected into the scar three times. No further local infections were observed at the scar site during the subsequent 12-month follow-up.

Background Patients with prior abdominal surgeries are at higher risk of intra-peritoneal adhesions near the trocar entry site, increasing the likelihood of organ injury during laparoscopic cholecystectomy (LC). This study evaluates a novel technique where the epigastric trocar is inserted first, after creating pneumoperitoneum, to allow safe dissection of adhesions under direct vision before placing the umbilical trocar. Methods This prospective study included 244 patients with symptomatic uncomplicated gallstone disease and a history of previous abdominal surgeries extending to the umbilicus. Patients were randomly assigned to two groups: Group I ( n  = 98) underwent traditional umbilical trocar-first LC using the Hasson technique, while Group II ( n  = 146) received LC using the epigastric trocar-first approach. Operative time, complications, and conversion rates were analyzed. Results There was no significant difference in the demographics between both groups. The epigastric trocar-first approach significantly reduced total operative time (41.6 ± 7.7 min vs. 46.8 ± 8.8 min, p  = 0.031) and small bowel injury rates ( p  = 0.006). Otherwise, intraoperative complications were comparable. Conversion to open surgery was lower in Group II (2.1% vs. 8.2%, p  = 0.012). Postoperative pain at 6 h was significantly lower in Group II ( p  = 0.001). Conclusions The epigastric trocar-first approach, offers a safer alternative for patients with prior abdominal surgeries when undergoing LC. This approach is safe; minimizes bowel injury risk, reduces conversion rates, and enhances patient recovery. This approach may also be beneficial in other laparoscopic procedures requiring safe entry in patients with prior abdominal surgeries. Further studies are recommended to validate its broader clinical application.

Background The appearance and position of navel which are considered as a marker for overall abdominal aesthetics, are important for the final results of abdominal surgeries. However, reconstructing and improving its appearance have been a challenge in plastic surgery. Hypothesis In this study, we aimed to compare satisfaction of the patients and the plastic surgery professors with the aesthetic results of the two methods of umbilical reconstruction: Mercedes (Y) incision versus inverted-V incision. Methods This is a randomized clinical trial performed on umbilicoplasty patients following abdominoplasty, breast reconstruction, or abdominal flap surgery whom referred to our center. They were divided into two equal groups of twenty patients with Mercedes (Y) incision and patients with inverted-V incision. The results of surgery were compared three months after the surgery by the opinions of patients, plastic surgery professors, and unbiased observers. Results The average scores of patients, professors, and observers showed that Mercedes (Y) had significantly higher scores compared to inverted-V incision in terms of position, size, shape, natural appearance, and the overall satisfaction. Surgical complications including stenosis, necrosis, and wound dehiscence were not statistically different in our small sample size. Conclusion In this study, Mercedes (Y) incision was preferred by all of the groups in all five parameters that were assessed including size, shape, position, natural appearance, and overall satisfaction. The simplicity of the Y incision with less visible scar makes it a suitable method for further investigations with a larger sample size. Level of Evidence I 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 .