Vertical umbilical incision achieves better cosmesis than circumumbilical incision in transumbilical laparotomy in neonates and young infants

Abstract Purpose: The transumbilical approach is widely used for minimally invasive surgery in children. We compared herein the postoperative cosmesis between two types of transumbilical approach, one involving a vertical incision and the other involving a circumumbilical incision.Methods: Patients with a transumbilical laparotomy before age 1 year were prospectively enrolled between January 2018 and December 2020. A vertical or circumumbilical incision was chosen at the surgeon’s discretion. A questionnaire about the appearance of the umbilicus was completed by the patients’ guardians at postoperative month 6 to assess satisfaction and determine the visual analog scale score. Patients receiving a relaparotomy via another site were excluded.Results: Forty patients were enrolled; 24 patients received a vertical incision while 16 received a circumumbilical incision. The incision length was significantly shorter in the vertical incision group (median: 2.0; range: 1.5–3.0 cm vs. median: 2.75; range: 1.5–3.6 cm) (P = 0.001). The patients’ guardians reported significantly higher satisfaction (P = 0.002) and higher scores on the visual analog scale (P = 0.046) in the vertical incision group (n = 22) than in the circumumbilical incision group (n = 15).Conclusion: A vertical umbilical incision can provide better, postoperative cosmesis than a circumumbilical incision.