INTRODUCTION: Improved cosmesis has been demonstrated using a transumbilical incision for placement of the peritoneal end of a ventriculoperitoneal shunt. We now present our experience with this technique. PATIENTS AND METHODS: From January 2005 until present, a prospective cohort of 25 children underwent placement of a ventriculoperitoneal shunt with the peritoneal shunt catheter being introduced into the peritoneum via an incision into the umbilicus. There were 17 boys and 8 girls. The age range at insertion was 6 days to 5 years (mean 1.2 years). RESULTS: The mean follow-up for this group was 3.2 years (range 2 months to 6 years). Of all patients, only one complication (4%) has occurred, although this did not lead to long-term issues. The infection rate for this small group was 0%. CONCLUSIONS: Placement of the peritoneal end of a ventriculoperitoneal shunt via an umbilical incision is effective, cosmetically appealing, and not more prone to complications than other standard incisions used on the anterior abdominal wall. Additionally, and based on our experience, this approach is quicker and almost bloodless with no long-term complications.