EN
TÜRKÇE
Oral Presentation - 61
Can the modified Tan-Bianchi Circum-umbilical approach be used exploring older children?
H Abdelkader, M Abdelatif, E Elshafi, KEM Debeki, M Shalabi
Pediatric Surgery Unit, Ain-Shams University, Cairo, Egypt
Abstract: Since Tan and Bianchi reported umbilical incision as an access for pyloromyotomy in infantile hypertrophic pyloric stenosis, many pediatric surgeons have used this approach for a number of other procedures. But most of these reports focused on the usefulness of such approach in neonates. This study aims to assess the clinical usefulness of the circum-umbilical approach for exploring the abdominal cavity of infants and older children with a variety of surgical intraabdominal diseases in order to achieve minimally invasive surgery with excellent cosmetic results. Methods: All patients who underwent a circumumbilical skin incision for an exploratory laparotomy in the period June 2009– October 2010 were reviewed. Age, operative procedure, conversions to standard laparotomy, complications and follow-up were recorded Results: A total of 27 infant and child with ages ranging from 3 months to 8 years had 28 operative procedures. The indications were: nonrotation of midgut in 2; intussusception in 13; complicated V-P shunts in 4; Meckel's diverticulum in 2; gastrotomy for removal of an impacted foreign body from stomach in 1; pyloroplasty for caustic injury of the pylorus in 1, lymphatic mesenteric cyst in 1, and complicated appendicitis in 3 . Conversion to a standard midline incision was necessary in one case. The complications encountered included wound infection in five; burst abdomen in one, and incisional hernia in two cases. Subsequent follow-up revealed that all incisions had healed and the scars were almost imperceptible as affirmed by parental satisfaction during outpatient clinic consultation. Conclusions: The circumumbilical approach appears to be safe, flexible and easily reproducible approach providing adequate exposure for some abdominal surgeries even in older infants and children as it had been tried successfully in neonates. The low complication rate and pleasing aesthetic outcome are much appreciated by parents and operators alike