Umbilicoplasty for Gastroschisis

A normally positioned aesthetic umbilicus that is patient acceptable is important to the psychological well-being of the child through to adulthood. Following intra-abdominal placement of the extruded edematous bowel, in children born with gastroschisis, closure of the wide 1.5–3.5 cm diameter umbilical port can be achieved in the manner of a “hinged bottle top,” using the splayed cord that is attached to the left margin of the port. The technique uses the natural spontaneous fascial contracture that occurs during drying of the umbilical cord to achieve a midline aesthetic umbilicus and a scarless abdomen. Umbilical hernia has not been a problem. Complications have been minor with early periumbilical cellulitis requiring antibiotics and the occasional “soft” wide umbilicus coming to late surgery. Long-term follow-up of 32 patients, now >20 years, confirms the patient acceptability of a normally placed aesthetic umbilicus and a scarless abdomen.