A novel modified trans-umbilical open technique for secure laparoscopic entry through the natural umbilical defect: Sheredi’s technique

Mohamed A. Sheredi; Stacey Jessica Jones

doi:10.18203/2349-2902.isj20253826

Authors

Mohamed A. Sheredi Pinderfields General Hospital, Yorkshire, U. K.
Stacey Jessica Jones Pinderfields General Hospital, Yorkshire, U. K.; St James' University Hospital, Leeds, U. K.

DOI:

https://doi.org/10.18203/2349-2902.isj20253826

Keywords:

Laparoscopic access, Open technique, Transumbilical, Linea alba, Trocar insertion, Surgical entry, Complication rate

Abstract

Background: Safe and efficient entry into the peritoneal cavity is essential in laparoscopic surgery. The umbilicus is a preferred site for trocar insertion; however, the prevalence and surgical utility of a small physiological defect in the umbilical linea alba are poorly documented. This study describes a novel open-access method, Sheredi’s modified trans umbilical open technique-which utilizes this anatomical feature and assesses its prevalence.

Methods: A prospective cohort study of 193 consecutive patients undergoing laparoscopic surgery by a single surgeon at the Mid Yorkshire NHS Trust between January 2020 and February 2023 was conducted. Open peritoneal entry was performed through a physiological umbilical linea alba defect, when present. Patients with umbilical or paraumbilical hernias, or with a history of prior umbilical surgery, were excluded. A prospectively maintained database captured demographic and operative data, including defect presence and size, access time, complications, and cosmetic outcomes. Associations between defect presence and age, sex, and BMI were analysed.

Results: Of the 193 patients (median age 44 years; 81 males, 112 females), 124 (67%) had a physiological umbilical defect. There was no significant association between defect presence and age, sex, or body mass index (BMI). No bowel, vascular, or visceral injuries occurred. The mean access time was 1.2 minutes. Three patients (1.6%) developed surgical site infections (SSIs); all were smokers, and one had diabetes. All patients reported satisfaction with the cosmetic outcome.

Conclusions: The author’s open technique is safe, rapid, and cosmetically favourable when a physiological umbilical defect is present, supporting its use as a primary peritoneal entry method in laparoscopic surgery.

Metrics

Metrics Loading ...

References

Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS. 2010;14(4):476-83. DOI: https://doi.org/10.4293/108680810X12924466007926

Quah GS, Eslick GD, Cox MR. Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair. J Gastrointest Surg. 2019;23:618-25. DOI: https://doi.org/10.1007/s11605-018-4047-8

Sayed AAA, EL-Maksood IMA, Mohammed RI. A Comparative Study of Laparoscopic and Open Appendectomy. Med J Cairo Uni. 2021;89(3):155-61. DOI: https://doi.org/10.21608/mjcu.2021.153782

Recknagel JD, Goodman LR. Clinical Perspective Concerning Abdominal Entry Techniques. J Minimally Invasive Gynecol. 2021;28(3):467-74. DOI: https://doi.org/10.1016/j.jmig.2020.07.010

Bucheeri MM, Sujit M, Ashish M, Abdulmenem YA. The use of optical trocars in abdominal entry among patients with obesity-A case series. Ann Med Surg. 2021;69:102698. DOI: https://doi.org/10.1016/j.amsu.2021.102698

Abdullah AA, Abdulmageed MU, Katoof FM. The efficacy of direct trocar versus Veress needle method as a primary access technique in laparoscopic cholecystectomy. Mustansiriya Med J. 2019;18:47-50. DOI: https://doi.org/10.4103/MJ.MJ_39_18

Vaishnani BV, Kachhadiya KR, Chauhan MR. A comparative study of the open versus closed method of pneumoperitoneum creation in laparoscopic surgery. Int Surg J. 2021;8(11):3344-7. DOI: https://doi.org/10.18203/2349-2902.isj20214368

Resutra R, Mahajan N, Gupta R. Trans umbilical first trocar access during laparoscopic surgery. Int J Res Med Sci. 2019;7(8):3039-43. DOI: https://doi.org/10.18203/2320-6012.ijrms20193145

Hegazy TO, Ali MH, Mohsen AA, Azhary M, Dayem AYA. Native Umbilical Defect for Laparoscopic Entry. Ann Afr Surg. 2020;17(3):116-9. DOI: https://doi.org/10.4314/aas.v17i3.6

Fitzgibbon R, Quinn T, Krishnamurty D, Maier RV, Simeone DM, Upchurch Jr GR. Abdominal wall hernias, in Greenfield’s Surgery Scientific Principles and Practice, 5th edi, Wolters Kluwer. 2017;1208-57.

Fathi AH, Soltanian H, Saber AA. Surgical anatomy and morphologic variations of umbilical structures. Am Surgeon. 2012;78(5):540-4. DOI: https://doi.org/10.1177/000313481207800534

Pozzo R, Arrangoizú R, Cordera F, Moreno E, Luque-De-León E, Muñoz M, et al. Trans umbilical laparoscopic access during laparoscopic procedures. Case Studies in Surg. 2017;3(1):1-5. DOI: https://doi.org/10.5430/css.v3n1p1

Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971;110:886-7. DOI: https://doi.org/10.1016/0002-9378(71)90593-X

Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lance JF. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Brit J Surg. 1997;84(5):599-602. DOI: https://doi.org/10.1046/j.1365-2168.1997.d01-1355.x

Dunne N, Booth MI, Dehn TCB. Establishing pneumoperitoneum: Verres or Hasson? The debate continues. Ann Royal Coll Surgeons Eng. 2011;93(1):22-4. DOI: https://doi.org/10.1308/003588411X12851639107557

Coste AH, Jaafar S, Parmely JD. Umbilical Hernia. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

European Centre for Disease Prevention and Control. Healthcare-associated infections: surgical site infections-Annual Epidemiological Report for 2017. Annual Epidemiological Report on Communicable Diseases in Europe. Available at: https://www.ecdc.europa.eu/en/publications-data/healthcare-associated-infections-surgical-site-infections-annual-1. Accessed on 15 October 2025.

Ismaila BO, Alayande BT. A Modified Open Primary Laparoscopic Surgery Port Placement through Umbilical Tube. Niger J Surg. 2019;25(1):76-9. DOI: https://doi.org/10.4103/njs.NJS_34_18