Laparoscopic vs Open Excision of Urachal Remnants in Children

Abstract

Introduction: A urachal remnant forms when the allantois fails to completely obliterate. This results in a spectrum of anomalies. It is generally accepted that urachal remnants should be excised. Traditionally, excision has been performed via an open umbilical approach. Recently, minimally invasive techniques have been applied toward the correction of urachal anomalies. However, there are few studies in the literature comparing open and laparoscopic excision in adults and none in children. Materials and methods:We performed a retrospective chart review of all patients undergoing open or laparoscopic excision of a urachal remnant in a single institution from June 2007 to January 2013.Results: There were 4 patients in the laparoscopic group and 10 in the open excision group. There was no difference in age at surgery between the two groups. There was no difference in operative time (laparoscopic: 66.75 min vs open: 57.2 min, p-value 0.50). There was a trend toward increased cost and longer post-operative length of stay in the laparoscopic group ($60594.05 vs $40454.83; 43.25 hours vs 9 hours) but neither was statistically significant (p-values 0.11 and 0.058, respectively). There were no complications in either group. Discussion: Laparoscopic excision of urachal remnants is a safe and effective alternative to open excision. In addition, the laparoscopic approach allows for excellent visualization of the entire urachal tract. Although patients undergoing laparoscopic excision had potentially longer hospital stays, this did not necessarily translate into higher costs.

Laparoscopic surgery for urachal anomalies: Time to shift paradigm?

“…Laparoscopic approach also helps to excise the urachal remnant completely under better vision lowering the risk of malignancy. [13]…”