title: Umbilical cord sparing technique for repair of congenital hernia into the cord and small omphalocele.
abstract: OBJECTIVE
  Current repair of small omphaloceles and hernias into the umbilical cord is a straightforward procedure, whose repair may result in a suboptimal cosmetic outcome. We describe a novel repair technique retaining the umbilical cord elements in an attempt to improve the cosmetic appearance of the umbilicus.
  
  
  METHODS
  Eight neonates were consecutively treated more than a ten-year period. Size of the fascial defects ranged 1 to 3cm (median, 2). Present technique entails incision of the amniotic sac without its detachment from the skin, reduction of the extruded contents under direct vision, and closure of the abdominal wall defect by circumferential suturing of peritoneum and fascia around the base of the amniotic sac. The amniotic sac is then re-approximated and folded to create an umbilical stump, which is trimmed and left to shed naturally.
  
  
  RESULTS
  All patients achieved a scarless abdomen with a normal appearing umbilicus in 6. The remaining 2 patients are awaiting surgery for persisting umbilical hernia repair and umbilicoplasty, respectively. Poor esthetic outcome was significantly associated with initial fascial defect ≥2.5cm in size (p=0.03).
  
  
  CONCLUSIONS
  Present technique is a simple and cosmetically appealing repair for umbilical cord hernias and small omphaloceles, especially effective when the size of the fascial defect is less than 2.5cm.
  
  
  METHODS
  IV (Treatment Study).
authors.affiliation: Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ceccanti
authors.affiliation: Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Falconi
authors.affiliation: Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Frediani
authors.affiliation: Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boscarelli
authors.affiliation: Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy.
authors.forename: Layla
authors.initials: L
authors.lastname: Musleh
authors.affiliation: Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy. Electronic address: da.cozzi@uniroma1.it.
authors.forename: Denis A
authors.initials: DA
authors.lastname: Cozzi
mesh_terms: D002921:Cicatrix / Q000517:prevention & control; D004954:Esthetics; D000071938:Fasciotomy; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010537:Peritoneum / Q000601:surgery; D013536:Suture Techniques; D014470:Umbilical Cord; D014472:Umbilicus / Q000601:surgery*
keywords: Ectopic liver; Exomphalos; Omphalocele; Scarless abdomen; Umbilical cord hernia; Umbilicus