Scarless reconstruction of circular umbilical defects after resection of endometriosis

Objective: Approximately 0.5–1% of patients diagnosed with endometriosis present with cutaneous lesions in the umbilicus. For symptomatic patients complete excision is mandatory and frequently results in resection of the entire umbilicus. The resulting circular defects require umbilical reconstruction to achieve a cosmetically satisfying result in these mostly young patients. Methods: We report on our surgical technique of choice used in patients with circular defects in projection of the umbilicus. The umbilical mass is widely excised down to the level of the fascia of the rectus muscle. When indicated diagnostic laparoscopy can be performed using the same incision. Defatted skin flaps of the surrounding tissue are mobilized and the apical flap is attached to the aponeurosis of the rectus muscle using non-resorbable suture. Without further incisions two lateral flaps are folded in the centre and attached to fascia using two non-resorbable stitches forming a 'neo'-umbilicus. Results: Postoperative course and wound healing was uneventful. The cosmetic result was satisfying for the patients. Conclusion: We report about a simple surgical technique applicable in patients with circular defects in projection of the umbilicus, which provides satisfying cosmetic results without prominent visible scars. Supplementary laparoscopic inspection of the abdominal cavity can be performed without further incisions.