title: A new paradigm of scarless abdominal surgery in children: transumbilical minimal incision surgery.
abstract: OBJECTIVE
  This study aimed to evaluate the use of a transumbilical incision for infants and children, as well as neonates, with various intraabdominal conditions.
  
  
  METHODS
  A retrospective study of transumbilical incision surgery was performed between June 2007 and June 2013. Patients were divided into two groups: group 1 of neonates and group 2 of infants and children. All operations were performed via an upper circumumbilical incision.
  
  
  RESULTS
  Thirty-six patients (22 males, 14 females) were treated via a transumbilical incision, with 20 patients in group 1 and 16 patients in group 2. A transverse incision extension was needed for 1 case in group 1 (intestinal atresia complicated by meconium peritonitis) and 4 cases in group 2 (two with ileus owing to adhesive bands, 1 with malrotation, 1 with ectopic pancreatic tissue in the duodenum). In cases with a dilated intestinal wall or intraabdominal adhesions, an optional extension of the transverse incision might be required. Only 1 case with ileus in group 2 developed a wound infection that was treated by drainage. The postoperative cosmetic results were acceptable in all cases.
  
  
  CONCLUSIONS
  The transumbilical incision yielded a sufficiently large surgical field, and the surgical condition was easily and directly viewed. In all 36 cases, an adequate operation was safely performed. This approach is a safe and effective method for various intraabdominal disorders in not only neonates but also infants and children, and leads to an imperceptible incision.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan. Electronic address: maedak@jichi.ac.jp.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ono
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan.
authors.forename: Satohiko
authors.initials: S
authors.lastname: Yanagisawa
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Baba
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Usui
mesh_terms: D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus
keywords: Children; Minimal incision surgery; Transumbilical incision