Laparoscopic Management of Complicated Urachal Remnants

Abstract

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

“…Until recently, excision of the urachal remnant was performed by a laparotomy with a long skin incision from the umbilicus to the suprapubic area [12] , [15] . After the description of a laparoscopic resection of the urachal remnant by Neufang et al [1] in 1992, several more reports on laparoscopic techniques have been published [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] . A laparoscopic resection of the urachal remnant has been suggested to be technically feasible and minimally invasive.…”

“…To alleviate this drawback, laparoscopic excision of the urachal remnant was first demonstrated in 1992 by Neufung et al [1] , and since then several trials of laparoscopic surgery to correct the urachal anomaly have been reported [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] . However, the techniques, including port placement arrangements and division and suture of the bladder, have not yet been standardized.…”

Case Report: Pre- and postnatal management of an allantoic cyst with patent urachus and single umbilical artery

“…Open surgery also required shorter hospital stays 16 . However, since the appearance and universal application of laparoscopy in 1995 17 , several studies have suggested that this method could be a safe and effective alternative with minimal morbidity 18 . Laparoscopic approach not only provides an all-around visualization of the urachal channel and fetal bladder but also improves patient’s general state and reduces post-operative pain more rapidly, as do all endoscopic procedures 16 .…”

Laparoscopic management of urachal cysts

“…Both of these series used basically the same technique and showed that a laparoscopic technique can be used safely and effectively to remove all urachal remnant tissue with minimal morbidity (21).…”