Novel technique and outcomes of umbilical reconstruction during cytoreductive surgery; a multi-centre study.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2025-01-21 DOI:10.1007/s10151-024-03095-y

E Cheng, P F Yang, S Khor, J Mui, M Sarofim, R Wijayawardana, N Ansari, C E Koh, D L Morris, N Ahmadi

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Abstract

Background: The goal of cytoreductive surgery for peritoneal malignancy is to remove all macroscopic disease, which occasionally requires the excision of the umbilicus. While the absence of the umbilicus can be aesthetically undesirable for patients, umbilical reconstruction is rarely performed due to the perceived complexity and increased risk of wound infections (Sakata et al. in Colorectal Dis 23:1153-1157, 2021). This study aims to evaluate the outcomes, cosmetic results and patient satisfaction of umbilical reconstruction during cytoreductive surgery.

Methods: Consecutive patients from a prospectively maintained database who underwent cytoreductive surgery with umbilical excision and reconstruction were evaluated. Our technique for umbilical reconstruction involved recreating the subcutaneous fat space and fashioning umbilical skin flaps that anchor to the anterior fascia. Outcomes assessed included post-operative infection rate, wound dehiscence, seroma formation, wound appearance and patient satisfaction.

Results: Umbilical reconstruction was performed on 50 patients, with 12 (24%) experiencing wound-related complications. Of these, eight patients (16%) had superficial wound infections, while one patient (2%) developed a deep wound infection; three patients (6%) required local wound drainage, though none needed surgical revision. There were no reports of wound seromas, skin necrosis, wound widening nor umbilical stenosis. All patients reported satisfaction with the outcome of their reconstruction.

Conclusions: Our novel technique for umbilical reconstruction during cytoreductive surgery did not negatively impact wound healing outcomes. Recreating the umbilicus improved cosmetic results and patient satisfaction, enhancing body image for those undergoing major abdominal surgery. This approach should be considered for patients undergoing major laparotomies that necessitates umbilical excision.

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细胞减少术中脐带重建的新技术与效果多中心研究。

背景：腹膜恶性肿瘤细胞减少手术的目的是切除所有肉眼可见的疾病，有时需要切除脐部。虽然没有脐带对患者来说在美学上是不可取的，但由于脐带重建的复杂性和伤口感染的风险增加，很少进行脐带重建（Sakata等人在结直肠疾病中23:1153-1157,2021）。本研究旨在评估细胞减少术中脐带重建的预后、美容效果和患者满意度。方法：从前瞻性维护的数据库中，对连续接受细胞减少手术、脐带切除和重建的患者进行评估。我们的脐带重建技术包括重建皮下脂肪空间和形成锚定在前筋膜上的脐带皮瓣。评估结果包括术后感染率、伤口裂开、血肿形成、伤口外观和患者满意度。结果：50例患者进行了脐带重建，其中12例（24%）出现了伤口相关并发症。其中，8例患者（16%）发生浅表伤口感染，1例患者（2%）发生深部伤口感染；3例（6%）患者需要局部伤口引流，但没有患者需要手术翻修。没有伤口血清肿、皮肤坏死、伤口扩大或脐狭窄的报道。所有患者均对重建结果表示满意。结论：我们在细胞减少手术中进行脐带重建的新技术对伤口愈合结果没有负面影响。重建脐部改善了美容效果和患者满意度，提高了接受大型腹部手术的人的身体形象。对于需要切除脐带的大剖腹手术患者，应考虑采用这种方法。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.