Surgical strategy of urachal remnants in children

Omphalomesenteric duct resection using an intraumbilical round incision or a transumbilical vertical incision: report of two cases

We report our experience with two patients who underwent omphalomesenteric duct resection: one for a patent omphalomesenteric duct and the other for a Meckel diverticulum connected to the umbilicus by a fibrous cord. We used an intraumbilical round incision and a transumbilical vertical incision, respectively. The first patient was a neonate with a patent omphalomesenteric duct who appeared to have a small stoma after ligature of the umbilical cord. Contrast media, injected through a catheter inserted into the stoma, entered the lumen of the small bowel. The second patient was an infant with a Meckel diverticulum connected to the umbilicus by a fibrous cord. After bloody stool was noted, nuclear imaging using 99^m technetium pertechnetate revealed a small, round area of intense tracer activity in the midabdomen, suggesting the presence of ectopic gastric mucosa. Using either an intraumbilical or a transumbilical incision is safe and provides good cosmesis.

Evaluation and management of urachal remnants in children

BACKGROUND

This study aimed to evaluate the diagnosis and treatment of pediatric patients with urachal remnants.

METHODS

Medical records of patients diagnosed with urachal remnants between 2015-2019 were evaluated retrospectively. Age, gender, admission complaints, diagnosis, size of cysts, the complications that developed, and treatment modalities were recorded.

RESULTS

The study population consisted of 15 cases including seven girls. Most of the cases were asymptomatic. The urachal remnants were detected by ultrasonography. The most common symptom in symptomatic patients was abdominal pain and umbilical discharge. Three patients required surgery and most of them were conservatively followed up. Complication, infection, and bladder rupture were observed in one case.

CONCLUSIONS

Follow-up of patients with urachal remnants can be performed conservatively. The type of complaint and the presence of clinical and radiological regression (if any) are important for deciding the treatment during the follow-up. However, conservative follow-up is more prominent today, as shown in this study.

Laparoscopic surgery for urachal remnants in pubescent children: a case series

BACKGROUND

Various techniques are applied in laparoscopic surgery for the treatment of urachal remnants, which are less invasive and associated with lower morbidity. We herein report a case series in which we treated urachal remnants and medial umbilical ligaments using a laparoscopic approach.

CASE PRESENTATION

From 2015 to 2019, seven patients (male, n = 5; female, n = 2) with a urachal remnant were treated by laparoscopic surgery in our institute. Five boys and two girls with a median age of 11 years (range 10-15 years) were enrolled in this series. The clinical results of laparoscopic treatment, the perioperative records, and the pathologic results were evaluated. The operation was performed with the use of three ports and an EZ access® (Hakko Medical, Nagano, Japan), which is a silicon cap for the wound retractor (Lap Protector®, Hakko Medical, Nagano, Japan). The removal of the urachal remnant and medial umbilical ligaments was completed with a median operative time of 92 min (range 69-128). The median hospital stay after surgery was 4 days (range 2-5). No patients developed intra-postoperative complications or recurrence.

CONCLUSIONS

Although our data are preliminary, complete laparoscopic removal of symptomatic urachal remnants and medial umbilical ligaments was a safe and effective minimally invasive approach, with better cosmetic outcomes.