Enhancing aesthetic outcomes in primary umbilical endometriosis: Novel four-flap neoumbilicoplasty with case insights and comprehensive literature review

Primary umbilical endometriosis (PUE) is a rare form of extragenital endometriosis, accounting for only 0.5%–1% of all endometriosis cases. Surgical excision is the primary treatment; however, it often results in disfigurement of the umbilicus, leading to aesthetic dissatisfaction. This case report aims to describe and discuss a simple surgical technique for aesthetically managing PUE. Our patient was a 35-year-old woman who presented with pain and bleeding from the umbilicus during menstruation. She denied any prior surgeries. Clinical examination and imaging revealed a small nodule within the umbilicus. The novel four-flap neoumbilicoplasty technique was employed, combining lesion removal and reconstruction in a single procedure, to achieve a high-quality aesthetic outcome. This technique is easily adoptable by general gynecologists, without advanced expertise or equipment. Its wider adoption could enhance surgical practice globally and build robust evidence in managing PUE.