title: Transumbilical laparotomy in infants: a novel approach for a wide variety of surgical disease.
abstract: OBJECTIVE
  Laparoscopy has kindled an interest in minimally invasive surgery in infants. To combine improved cosmesis with the advantages of open exposure, we adopted the transumbilical approach for laparotomy in babies up to 26 months of age.
  
  
  METHODS
  Only hemodynamically stable babies were considered candidates. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline. The procedure was completed in the standard, open fashion by positioning the incision over the area of interest, and the periumbilical wound was closed subcuticularly.
  
  
  RESULTS
  Since 1998, 42 infants have undergone 44 transumbilical laparotomies, with only one conversion to a traditional incision (operating time, 35 to 202 minutes). Twenty-nine newborns were treated transumbilically for duodenal atresia/stenosis/web (n = 11), malrotation (n = 7), intestinal atresia/stricture (n = 5), and other pathology (n = 7). Thirteen older infants (1 to 9 months) were treated transumbilically for intussusception (n = 4), malrotation (n = 4), and other pathology (n = 5). Three toddlers (13 to 24 months) also underwent successful transumbilical laparotomy. There were 2 wound infections and one anastomotic leak.
  
  
  CONCLUSIONS
  These results suggest that a transumbilical approach is feasible, safe, and cosmetically superior to the open operation for a broad spectrum of surgical procedures in infants, and it may also be useful in older children.
authors.affiliation: Inova Fairfax Hospital for Children, Falls Church, VA, USA.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Soutter
authors.forename: Allyson A
authors.initials: AA
authors.lastname: Askew
mesh_terms: D002675:Child, Preschool; D004380:Duodenal Obstruction / Q000151:congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery; D007410:Intestinal Diseases / Q000601:surgery; D007415:Intestinal Obstruction / Q000601:surgery; D007443:Intussusception / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D014472:Umbilicus / Q000601:surgery*