Abdominal wall dimensions and umbilical position vary widely with BMI and should be taken into account when choosing port locations

Abstract

There is a clear relationship between increasing BMI and a drop in umbilical position as well as an increase in abdominal dimensions. We recommend determining umbilical position and abdominal dimensions prior to placing ports and shifting port positions toward target quadrants.

Intraperitoneal onlay mesh repair (IPOM) plus technique using a hybrid procedure of open laparotomy and laparoscopic approach (hybrid IPOM plus) for incarceration of umbilical hernia in a severely obese patient: a case report

“…The IPOM and IPOM plus methods can both be performed either by open surgery or laparoscopically, but the incisional wound is much larger in purely open surgery. Among severely obese patients, laparoscopic surgery is minimally invasive but difficult, as subcutaneous and visceral fat make insertion of the first trocar difficult in addition to other problems, including restricted port mobility [7,8]. The small-incision technique and optical technique can be used in laparoscopic approaches for severely obese patients.…”

“…In the IPOM plus method, in addition to IPOM, the hernia orifice is also closed by direct suturing, a procedure that is anticipated to reduce the recurrence rate [4][5][6]. Laparoscopic surgery in severely obese patients, however, is a difficult procedure, as subcutaneous fat and visceral fat make the first trocar insertion difficult, in addition to other problems, including restricted port mobility [7,8].…”

Bladeless Direct Optical Trocar Insertion in Laparoscopic Procedures on the Obese Patient

“…A distinguishing characteristic of obese patients for abdominal entry is a caudally displaced umbilical position due to increased BMI, 15 but the cephalocaudal relationship between the aortic bifurcation and umbilicus varies widely, and it is not related to BMI in anesthetized patients. 16 …”

“…Difficulties of entry into the abdomen in obese patients are associated with the expanded thick fatty layer of the abdominal wall, especially with translocation of the umbilicus, which is more caudal to the normal umbilical site and just below the aortic bifurcation. 4,5 Therefore, manipulations during entry with grasping the abdominal wall are difficult because of abdominal wall thickness as well as a large-vessel trauma timidity.…”

L’ombilic chez l’enfant

“…Chez l'adulte sa position varie avec l'âge et l'IMC [4]. Six formes sont décrites, en T, verticale, horizontale, ronde, déformée, protruse [2,[5][6][7]. Chez l'enfant l'ombilic est plus souvent protrus dans les premières années de vie.…”