title: Transumbilical approach for neonatal surgical diseases: woundless operation.
abstract: OBJECTIVE
  The transumbilical approach by means of a circumumbilical incision has up until recently been the main method for performing a pyloromyotomy. This study aims to assess the clinical usefulness of the transumbilical approach for neonates with a variety of surgical intraabdominal diseases in order to achieve minimally invasive surgery with excellent cosmetic results.
  
  
  METHODS
  In 14 neonates with surgical diseases (3 hypertrophic pyloric stenoses, 3 ileal atresias, 2 jejunal atresias, 1 duodenal stenosis, 1 duodenal atresia, 2 ovarian cysts, 1 malrotation, and 1 segmental dilatation of ileum), treatment using a transumbilical approach by means of a half circumumbilical incision was performed at our institution. The clinical features of 14 cases were evaluated.
  
  
  RESULTS
  Eight cases except for three patients with hypertrophic pyloric stenosis, two with ovarian cysts and one with intestinal malrotation underwent the operation within 4 days of birth. In 10 of 14 cases, the umbilicus was incised on its upper half circumference, while the umbilicus of 4 cases was incised on its lower half circumference. In one ileal atresia patient with a remarkable degree of oral intestinal dilatation, a slight additional transverse incision was added. In four cases (1 case with ileal atresia, 2 cases of an ovarian cyst, and 1 case with a segmental dilatation of the ileum), laparoscopy-assisted transumbilical surgery was performed. In all cases, no operative complications were encountered. Postoperatively, there was no wound in appearance and the umbilicus appeared to be normal.
  
  
  CONCLUSIONS
  The transumbilical approach with or without laparoscopic assistance is considered to be a feasible, safe, and cosmetically excellent surgical procedure in neonates with a wide variety of surgical intraabdominal diseases.
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. taji@pedsurg.med.kyushu-u.ac.jp
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Tajiri
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ieiri
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Kouji
authors.initials: K
authors.lastname: Masumoto
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nishimoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D004954:Esthetics; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D010048:Ovarian Cysts / Q000601:surgery*; D014472:Umbilicus / Q000601:surgery*