Laparoscopic approach to Meckel's diverticulectomy

Abstract

IrelandCorrespondence to: Mr R. 6. Stephens The arrival of videoendoscopy has facilitated a wide range of endoscopic operative procedures across a variety of surgical disciplines, including gynaecology, otorhinolaryngology, orthopaedics and most recently general surgery. Laparoscopic cholecystectomy is currently the most common major abdominal operation performed endoscopically . Increasing familiarity with this new technique has resulted in a growing list of operations that can be performed with the aid of the laparoscope. The first laparoscopic approach to performing Meckel's diverticulectomy for acute inflammation is described. TechniqueA 28-year-old man with a previous appendicectomy presented with acute abdominal pain. A diagnostic laparoscopy was performed using a 10-mm trocar inserted below the umbilicus and a 5-mm trocar in the right iliac fossa. This revealed a swollen and inflamed Meckel's diverticulum. The diverticulum and its attached loop of small intestine were brought onto the surface of the abdominal wall (Figure 1 ) by pulling the diverticulum into the 10-mm trocar at the umbilicus and then removing the trocar from the abdominal cavity. A 3-mm extension to the incision was required to allow the loop of small intestine to come onto the surface. With the loop so exteriorized (Figure 2), the Meckel's diverticulum was then simply removed using a TA55 stapler (Auto Suture, Dublin, Ireland ) and the small bowel was replaced into the peritoneum. The two wounds were closed with subcuticular absorbable sutures. The patient recovered full mobility the following day and was discharged home on a normal diet on the third day after operation. Histology confirmed the presence of an acutely inflamed Meckel's diverticulum, containing gastric-type epithelium. DiscussionThe advantages of laparoscopy over laparotomy include rapid recovery of full muscle function and the lack of postoperative pain. In this patient, the laparoscope was used to make a diagnosis and to facilitate a standard operation by exteriorizing the relevant segment of small intestine. With the introduction of laparoscopic stapling devices, Meckel's diverticulectomy could be performed entirely within the peritoneal cavity under laparoscopic control, but this would probably not confer any great advantage over the procedure adopted in this case. The use of diagnostic laparoscopy is recommended in all patients with atypical abdominal pain for the purposes of establishing an accurate diagnosis and to perform definitive surgery where feasible. ReferencesOlsen DO. Laparoscopic cholecystectomy. Am J Sury 1991 ; 161 : 339 -44.

Meckel’s diverticular complications in children: is laparoscopy the order of the day?

“…Laparoscopic intracorporeal or laparoscopic-assisted extracorporeal Meckel's diverticulectomy has emerged as a versatile option in addressing the diverse complications of MD. Attwood et al [9] reputedly described the first laparoscopic assisted extracorporeal Meckel's diverticulectomy for acute inflammation, by application of staplers at the neck of the diverticulum. However, this procedure had potential inherent risk of leaving behind ectopic epithelium or the peptic ulcers in the adjacent ileal mucosa.…”

“…Diagnosis and management of complicated or incidental MD in children has undergone a sea change in the minimal access era [3][4][5][7][8][9][10][11][12][13][14][15][16][17]. The diagnosis of Meckel's diverticular complications based on the clinical features and conventional radiological modalities is fraught with limitations as MD is a mobile structure and mimics other common conditions.…”

“…Diagnostic laparoscopy has been recommended ahead of bi-directional endoscopy in the evaluation of LGIB as air insufflation during the procedure might hinder successful laparoscopic evaluation under the same general anesthesia [4]. Laparoscopic evaluation also aids in the diagnosis of other complications of MD such as intestinal obstruction due to Meckel's diverticular bands and Meckel's diverticulitis, which are difficult to ascertain pre-operatively with conventional imaging modalities [8,9]. Laparoscopic intracorporeal or laparoscopic-assisted extracorporeal Meckel's diverticulectomy has emerged as a versatile option in addressing the diverse complications of MD.…”

“…The advent of laparoscopy and its safe application in children over the past decade has opened new avenues in the diagnosis and management of complicated as well as incidental MD [3][4][5][7][8][9][10][11][12][13][14][15][16][17]. Our case series illustrates the utility of laparoscopic assistance in the management of varied complications associated with MD.…”

Laparoscopic Interventions in the Gut: Yesterday, Today, and Tomorrow

“…Among the list of other procedures not so far mentioned are laparoscopic gastrostomy [148], laparoscopic insertion of feeding jejunostomy [149], lapa roscopic management of bile peritonitis after liver biopsy [150], Meckel diverticulectomy [151], small bowel resection [152], deroofing of simple hepatic cysts [153], laparoscopic Laparoscopic Interventions in the Gut: Yesterday, Today, and Tomorrow gastropexy for gastric volvulus [154], Billroth II gastrectomy for benign gastric ulcer [155,156], and laparoscopic cardiomyotomy for achalasia [157,158]. The advantage of many of these over conventional methods is du bious or at best unproven.…”