Omphalectomy Procedure: Surgical Technique and Considerations
Omphalectomy is a surgical procedure involving complete removal of the umbilicus, typically performed as part of cytoreductive surgery for ovarian cancer or to address umbilical pathology.
Indications for Omphalectomy
- Primary indication: Component of cytoreductive surgery for ovarian cancer 1
- Secondary indications:
Surgical Technique for Omphalectomy
Preoperative Preparation
- Complete standard preoperative assessment
- Obtain informed consent discussing potential cosmetic implications
- Mark the surgical site with patient in standing position
Surgical Steps
Initial Incision
- Create a circumferential incision around the umbilicus 4
- Extend the incision to include any visible pathology
Dissection Technique
Deep Dissection
Fascial Closure
- Close the fascial defect using non-absorbable sutures in an interrupted fashion
- Ensure secure closure to prevent hernia formation
Skin Closure Options
- Primary closure with subcuticular sutures for minimal scarring
- Umbilical reconstruction if desired (see reconstruction section)
Specific Considerations for Ovarian Cancer
As Part of Cytoreductive Surgery
- Omphalectomy is performed as part of omentectomy in advanced ovarian cancer 1, 5
- Complete omentectomy (including umbilicus if involved) is standard for advanced disease 5
- The procedure contributes to maximal cytoreduction, which is associated with improved survival 1, 5
- Each 10% increase in maximal cytoreduction is associated with a 5.5% increase in median survival time 1, 5
Surgical Approach in Ovarian Cancer
- For early-stage disease: Infracolic omentectomy (may include umbilicus if involved) 5
- For advanced disease: Complete omentectomy with removal of all visible disease 1, 5
- May be performed during primary debulking or interval debulking surgery 1
Umbilical Reconstruction Techniques
If cosmetic reconstruction is desired following omphalectomy:
Double Opposing "Y" Technique 4
- Create a double opposing "Y" incision on the abdominal flap
- Suture the edges to create a three-dimensional umbilical depression
- Complete healing achieved in 14-21 days in most cases
Linear Incision Technique 6
- Complete resection of the umbilical scar
- Create a linear incision at the site of the new umbilicus
- Invert skin edges and suture to the linea alba
- Leave 1 cm space between skin borders for secondary wound healing
Simplified Technique for Children 7
- Particularly useful in pediatric cases
- Creates a natural-looking umbilical scar with minimal technical complexity
Potential Complications and Management
- Wound infection: Treat with appropriate antibiotics and wound care
- Dehiscence: May require secondary closure or healing by secondary intention
- Hernia formation: May require subsequent repair
- Cosmetic dissatisfaction: Consider secondary umbilical reconstruction
- In ovarian cancer cases, risk of tumor recurrence if inadequate resection 1
Postoperative Care
- Regular wound assessment and dressing changes
- Monitor for signs of infection or dehiscence
- Follow-up to assess wound healing and cosmetic outcome
- In cancer cases, continue with planned adjuvant therapy as indicated
Special Considerations
- For umbilical pilonidal sinus, total omphalectomy is typically reserved for recurrent cases 2
- In neonates with umbilical disorders, modified techniques may be employed to remove the entire umbilical vein 3
- Consider patient preferences regarding cosmetic reconstruction when planning the procedure
Omphalectomy is an important surgical procedure, particularly in gynecologic oncology, where it contributes to improved survival outcomes through maximal cytoreduction in ovarian cancer patients.