Umbilicus in Laparoscopy

Laparoscopic surgery is a less invasive treatment with faster recovery time, less pain, and less scaring than conventional open surgery. It has become popular in many fields of surgery including cancer surgery. There are studies which examines the factors related to infection and incisional herniation after laparoscopy at the umbilicus, as compared with those at remote sites.

Umbilical port-site infections after video-laparoscopic cholecystectomy (VLC) are frequent complications. The tse of topical rifamycin for prevention of post-VLC umbilical infections is reported in literature.

The wound infection rate was found to be 6%: 7% at the umbilicus (9% after cholecystectomy and 2% after other operations [p<0.05]) and 0% at remote sites (p<0.05). Excluding cholecystectomy, the umbilical infection rate was 2%, similar to that at remote sites.

The postoperative ventral hernia rate was at 0.8%, the same at the umbilicus as elsewhere. The rate was similar for gallbladder and nongallbladder operations and correlated with the postoperative wound infection rate, but not with the preexisting fascial defect rate. Wound infection at the umbilicus is similar to that at other sites, except after cholecystectomy. Postoperative ventral hernia at the umbilicus is similar to that at other sites and not related to preexisting fascial defects.

Postoperative umbilical pain occur sometime while doing laparoscopic surgery with a need for analgesics, presence of signs of inflammation of the umbilical wound, rarely wound dehiscence of the umbilical skin sutures also occur, and the presence of incisional umbilical hernia on the postoperative day can be treated statistically significantly better in the rifamycin group compared with the control group.

Omphalitis is a minor postoperative complication after laparoscopic surgery in few cases. It is treated quite simply as an outpatient problem, but occasionally omphalitis represents discomfort for the patient, and it can cause a delay in the resumption of routine work of patient. But, above all, omphalitis is a risk factor for the development of incisional umbilical hernia, which may occur in greater than 1% of cases.

CONCLUSIONS:

Umbilicus is an ideal port site for Minimal Access Surgery and Topical administration of rifamycin to the umbilicus in the pre, intra and postoperative periods was a rapid, safe, and economic way to reduce infective complications after laparoscopic surgery.