Retrospective Study
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World J Gastroenterol. Jul 7, 2014; 20(25): 8173-8178
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8173
Laparoscopic approach to Meckel's diverticulum
Alfonso Papparella, Fabiano Nino, Carmine Noviello, Antonio Marte, Pio Parmeggiani, Ascanio Martino, Giovanni Cobellis
Alfonso Papparella, Antonio Marte, Pio Parmeggiani, Departments of Paediatrics, Paediatric Surgery, Faculty of Medicine, Paediatric Surgery-Second University of Naples, 80138 Naples, Italy
Fabiano Nino, Carmine Noviello, Ascanio Martino, Giovanni Cobellis, Paediatric Surgery Unit-Salesi Children Hospital, 60121 Ancona, Italy
Author contributions: Papparella A and Cobellis G operated on the patients, have critically reviewed the data and the final version of the paper to be published; Papparella A, Nino F and Noviello C wrote the paper, have made a substantial contributions to conception and design, acquisition, analysis and interpretation of data; Marte A, Parmeggiani P and Martino A have drawn and revised the article for important intellectual content.
Correspondence to: Alfonso Papparella, MD, Associate Professor of Departments of Paediatrics, Paediatric Surgery, Faculty of Medicine, Paediatric Surgery-Second University of Naples, Largo Madonna delle Grazie 1, 80138 Naples, Italy. alfonso.papparella@unina2.it
Telephone: +39-81-5665352 Fax: +39-81-5665992
Received: November 20, 2013
Revised: February 19, 2014
Accepted: April 5, 2014
Published online: July 7, 2014
Processing time: 225 Days and 13.2 Hours
Abstract

AIM: To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers.

METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted (TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years (range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was established based on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients’ demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed.

RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min (range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d (range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years (range 10 mo-10 years).

CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel’s diverticulectomy is safe and effective in the treatment of MD, with excellent results.

Keywords: Meckel’s diverticulum; Laparoscopy; One trocar surgery; Gastrointestinal bleeding; Minimal invasive surgery; Ileal duplication; Jejunal hemangioma

Core tip: The Authors report a retrospective review on laparoscopic management of Meckel’s diverticulum (MD). The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. The abdominal exploration was performed with a 10 mm operative laparoscope and the complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. Patients’ demographics, main clinical features, diagnostic investigations etc. were registered and analyzed. Meckel’s diverticulum was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Our study confirms the value of laparoscopy in the management of MD for providing a definitive diagnosis and directing the subsequent surgical approach.