Possibility of sparing umbilicus following hernia repair during abdominoplasty in multiparous obese females
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Objectives: This study aimed to evaluate the outcome of concomitant umbilical hernial repair and abdominoplasty in multiparous obese females. Patients & methods: After application of inclusion criteria, the study included 26 multipareous females with mean age of 30.2+5.3 years, number of children of 3.2+1.1 child, body mass index (BM) of 32+2 kg/m2 and preoperative waist circumference (WC) was 127.6+9.9 cm. Operative procedure included open excisional lipectomy with preservation of the umbilical cicatrix with surrounding skin and a leash of blood supply, mesh repair of the umbilical hernia, plication of both rectus sheaths with adjustment of flanks to reduce WC and wound closure after suction drainage. Umbilical preservation outcome, postoperative (PO) WC measurements were taken at one and 6 months after surgery. The frequency of recurrent umbilical hernia was reported at the end offollow-up for 6 months. Results: Total operative morbidity was 19.2%; 2 patients (7.7%) had wound infection; one patient (3.8%) had wound seroma, all had responded to conservative treatment and 2 patients (7.7%) had wound end dog-ear that was corrected under local anesthesia as outpatient procedure. Twenty patients had well-sited, normally appearing umbilicus with healthy skin and good vascularity with an umbilical preservation success rate of 77%. Six patients had partially impaired vascularity manifested as spots of mild discoloration in 2 patients, superficial skin sloughing of the umbilical edge skin in one patient and umbilical wound infection in one patient. These two patients responded to conservative treatment without wound dehiscence. In 3 patients the umbilicus was slightly caudally shifted. WC estimated at one and 6-m PO showed significant reduction compared to preoperative WC, but was significantly wider compared to WC estimated at 1-m PO. Conclusion: The applied procedure of abdominoplasty with umbilical preservation after repair of umbilical hernia is a safe, effective procedure with good aesthetic results and free of PO hernial recurrence. Key words: Umbilical preservation, abdominoplasty.