Definition and Overview

Umbilectomy, also referred to as omphalectomy, is a surgical procedure wherein the umbilicus or the belly button is removed typically due to large umbilical hernias.

Who Should Undergo and Expected Results

Umbilectomy is not a commonly conducted surgical procedure and is typically indicated for large umbilical hernias.

An umbilical hernia is a defect in the abdominal wall caused by the umbilical ring’s failure to close, which causes the abdominal contents to protrude out. The protruding abdominal contents, typically the intestines, are thus merely covered with the normal skin of the umbilicus and the underlying subcutaneous tissues. In the majority of cases, these hernias are small, and some may even close spontaneously. The condition is typically asymptomatic and presents as the umbilicus protruding out. Incarceration and strangulation of the abdominal contents are rare, but can occur. Incarceration presents with abdominal pain, a firm mass in the umbilicus, and signs of obstruction such as vomiting. Large umbilical hernias typically occur in patients who are obese and usually have associated lesions on the skin. In some instances, particularly in patients with ascites, these umbilical hernias can develop fissures or even rupture. These cases require urgent surgical intervention.

The presence of masses on the umbilicus may also require umbilectomy. Often, these masses are benign, such as cysts, lipomas or fibromas. Tumours arising from embryonic remnants such as the urachus may also occur. There have also been reports of endometriosis in the umbilicus. Treatment of these tumours usually involves surgery.

Umbilectomy may also be necessary for infections of the umbilicus. Most of these infections, such as omphalitis, can be managed conservatively with antibiotic therapy. Chronic infection and inflammation of the umbilicus, such as that caused by prolonged contact and irritation with a foreign body, may result in the formation of granulomas. If small, these may be managed with the application of creams containing silver nitrate. However, large granulomas may require excision. Progressive infections of the umbilicus may lead to the development of necrotising fasciitis, a dreaded condition resulting in gangrene that requires aggressive surgical debridement.

How is the Procedure Performed?

After routine prepping and antisepsis, an incision around the umbilicus, typically a transverse elliptical incision, is carried out. The incision may be extended to the supraumbilical or infraumbilical crease. In recent years, a laparoscopic approach to umbilectomy and repair of the underlying condition has also been utilised.

The umbilical area is then explored, making sure to evaluate all identifiable structures, such as the umbilical arteries, vein, and urachus. Excision or repair of the underlying pathologic condition is then performed. For large umbilical hernias, after the viscera has been mobilised and returned to the abdominal cavity, a prosthetic mesh may have to be implanted.

For abdominal wall closure, the fascia is mobilised and if possible, closed using running or interrupted sutures. Finally, the skin of the umbilicus is closed. As much as possible, a natural-appearing umbilicus should be re-created. An interrupted suture may be used to attach the umbilicus to the underlying fascia. In cases where the umbilical skin is redundant, partial excision or umbilicoplasty may be necessary. If the entire umbilicus has been removed, umbilical reconstruction and the creation of a neoumbilicus may have to be performed.

Possible Risks and Complications

Surgeries on the umbilicus are generally safe, and complications are usually related to the underlying pathology. Pain after the procedure is generally tolerable. Bleeding is rare, although the formation of a hematoma after the procedure may occur if a large cavity remains. Other complications are related to the wound, and may include infections and wound dehiscence, particularly in patients with infectious pathologies. These can usually be managed with proper dressing and antibiotic treatment. In cases of umbilical hernias, thinned out skin and subcutaneous tissues may lead to the erosion of the mesh, requiring subsequent removal.

Reference:

  • Schwartz’s Principles of Surgery 9th edition
  • Mastery of Surgery 5th edition
  • Surgery of the Abdominal Wall
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