Video-Assisted Transumbilical Meckel's Diverticulectomy in Children

Abstract

The treatment of Meckel's diverticulum (MD) in children is resection. Some data exist for the use of laparoscopic resection. The Video-Assisted Transumbilical (VAT) single-trocar technique has been recently described for appendectomy. We also have used this technique for the resection of MD. The purpose of this study is to report our experience with laparoscopic-assisted resection of MD using both the three-trocar and the single-trocar techniques. The Institutional Review Board approved our retrospective chart review of all patients with the diagnosis of MD. Only the cases that were treated via laparoscopy were included. Technique of resection was at the discretion of the surgeon. Nine patients underwent laparoscopic resection of an MD from 2000 to 2005. Four patients underwent the three-trocar technique (LAP n = 4) and the remaining five underwent the video-assisted transumbilical single-trocar technique (VAT n = 5) procedure. Indications for surgery included gastrointestinal bleeding (VAT n = 3; LAP n = 2), malrotation (LAP n = 2), intussusception (VAT n = 1), and abdominal pain (VAT n = 1). All patients were male, and ages ranged from 7 months to 17 years for the VAT group and 8 months to 15 years for the LAP group. The average length of surgery for the LAP versus VAT was 128 minutes (94–170 minutes) and 81.4 minutes (42–96 minutes) respectively. Of the five patients undergoing LAP, two Ladd's procedures and three appendectomies were included during the same anesthesia. Only a single appendectomy procedure was performed during a VAT. The average time until full feeds with the LAP and VAT was 4.3 days (2–8 days) and 2.0 days (1–3 days) respectively. The overall length of stay with LAP versus VAT was 4.3 days (2–8 days) and 3.7 days (2–5 days). Only one case using the LAP method required conversion to an open laparotomy. Though no randomized trial for the removal of MD exists, our data suggest that the use of laparoscopy for removal of both symptomatic and asymptomatic MD is safe and effective. Additionally, the one trocar technique is feasible and may be beneficial in terms of fewer incisions and operative costs; however, more patients need to be studied.

Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century

“…The treatment for symptomatic Meckel's is resection, either laparoscopically or by way of open surgery, with or without a wedge or segment of the adjacent intestine. [20] Several laparoscopic or laparoscopy-assisted techniques allow for the resection of Meckel's, by way of 1 trocar or 3, [62] and by resection intraperitoneally or by exteriorization of the intestinal segment bearing the Meckel's through an abdominal incision. [29,62] Laparoscopic or laparoscopy assisted resection of Meckel's is described as safe and effective.…”

“…[29,62] Laparoscopic or laparoscopy assisted resection of Meckel's is described as safe and effective. [29,62]…”

Diagnosis of Bleeding Meckel's Diverticulum in Adults

“…Recently, balloon-assisted enteroscopy (BAE) has increasingly been used, providing endoscopic visualization of small bowel pathologies. Given that most MDs are located within 100 cm of the ileocecal valve (ICV) [ 5 ], a retrograde BAE approach could feasibly reach MD lesions and, therefore, might provide an effective diagnostic tool for MD [ 6 ]. Therefore, the aim of our multicenter study was to evaluate the diagnostic yield and accuracy of different modalities, including BAE, for the diagnosis of bleeding MD in adults, and to use the outcome of our evaluation to determine which diagnostic modality would be most useful for the preoperative diagnosis of bleeding MD in adults.…”

Single-port laparoscopic surgery in children: A new alternative in developing countries

“…[ 2 ] They included abdominal operations such as appendectomies,[ 3 4 5 ] cholecystectomies,[ 6 7 8 ] splenectomies[ 9 ] and intestinal surgery. [ 10 ] Urologic procedures have also been reported: Pyeloplasty,[ 11 ] nephrectomy for ureteropelvic junction obstruction or multicystic dysplastic kidney[ 12 ] and varicocelectomy. [ 13 ]…”