title: A comparison of circumumbilical and transverse abdominal incisions for neonatal abdominal surgery.
abstract: OBJECTIVE
  Although neonatal bowel surgery traditionally involves a transverse abdominal incision, several authors have reported that the circumumbilical incision is effective and cosmetically appealing. We report the first study comparing the circumumbilical incision to the transverse abdominal incision for a variety of neonatal abdominal operations.
  
  
  METHODS
  Retrospective cohort analysis comparing the circumumbilical incision to the transverse abdominal incision for neonates who underwent surgical repair of malrotation, duodenal atresia/web, or intestinal atresia/web was performed between 1999 and 2009.
  
  
  RESULTS
  One hundred thirty-two patients underwent a laparotomy through a transverse abdominal incision (n = 106) or a circumumbilical incision (n = 26). Baseline characteristics between groups were similar. No differences were found when comparing operative time, postoperative days on a ventilator, narcotic infusion, time to full feeds, length of hospital stay, incidence of surgical site infection, and bowel obstruction. Although more incisional hernias occurred in the circumumbilical incision group (38%) than the transverse abdominal incision group (6%), all hernias in the circumumbilical group resolved without intervention, whereas 33% required surgical repair in the transverse abdominal group.
  
  
  CONCLUSIONS
  Because of its cosmetic advantages and similar outcomes to the transverse abdominal incision, the circumumbilical incision should be considered as an alternative to the transverse abdominal approach in neonatal surgery.
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Megha
authors.initials: M
authors.lastname: Suri
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D015331:Cohort Studies; D004065:Digestive System Abnormalities / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology