Purpose: The umbilicus is an important aesthetic landmark and its absence o
r deformity may be associated with poor self-image. In patients born with b
ladder exstrophy the umbilicus is attached to the upper margin of the bladd
er and reconstructive surgery often removes the navel. The umbilicus marks
the waistline and serves to complete the harmony of the curved lines above
and below the waist. We present our experience with children born with exst
rophic anomalies during the last 2 decades.
Materials and Methods: Our database included 61 children born with classic
bladder and 8 born with cloacal exstrophy treated between 1980 and 1998, We
performed primary reconstruction in 35 children, while 34 children and you
ng adults were referred for secondary surgical repair, including bladder au
gmentation, continent diversion, genitoplasty and so forth. Neoumbilicoplas
ty was done in all of the former and in 30 of the 34 latter cases. Early in
the series a V-shaped flap was raised and buried subcutaneously. The flap
eventually became a tube around the cystotomy tube and the cicatrix formed
the umbilical dimple. This method necessitated packing with iodoform gauze
for 4 weeks with weekly dressing. The technique evolved into a tubularized
U-shaped flap. A rubber tube was placed indwelling as a stent to maintain i
nward projection of the neoumbilicus.
Results: In 66 of the 69 cases the early results of umbilicoplasty were des
cribed by the surgeon as excellent or satisfactory. In 3 cases the neoumbil
icus appeared flat, lost depth and was described as unsatisfactory. Long-te
rm followup of more than 1 year was available in 48 patients, of whom 2 und
erwent umbilical repositioning for an off center or low umbilicus and 3 und
erwent repeat umbilicoplasty for a flat umbilicus that had lost depth. The
best cosmetic results were achieved in patients with a relatively thick lay
er of subcutaneous fat, whereas cosmesis was suboptimal in thin children. N
evertheless, the patients and parents were generally pleased with the umbil
ical appearance even when the surgeon was not.
Conclusions: Although the navel is a functionless depressed scar, it repres
ents an important and pleasing landmark. Umbilical construction should be a
ttempted early during functional closure or urinary diversion.