Results of umbilicoplasty for bladder exstrophy

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.