Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults

Evaluation of the Management of Urachal Carcinoma: A Single-Center Experience over 13 Years

INTRODUCTION

Urachal carcinoma is characterized by high malignancy, poor prognosis, and late stage of diagnosis. There is a lack of unanimous clinical treatment guidelines. We summarize the characteristics, treatment, and outcomes of urachal carcinoma from our center, hoping to provide a reference for diagnosis and treatment.

METHODS

We retrospectively analyzed the clinical data of 21 patients with urachal carcinoma who were treated at our center from January 2010 to August 2022, and all patients were followed up.

RESULTS

The average survival time was 67.1 ± 9.1 (ranging from 49.3 to 84.9) months. The average relapse-free survival was 48.8 ± 9.9 (ranging from 29.5 to 68.2) months. Six patients received adjuvant therapy, mainly chemotherapy. Five patients died during follow-up.

CONCLUSIONS

Early physical examination may be helpful for early detection of urachal carcinoma. Surgical treatment is still preferred for localized urachal carcinoma. Lymph node dissection may facilitate accurate staging, and positive margin usually results in a worse prognosis. Adjuvant therapy, mainly chemotherapy, may help improve the prognosis. The application of radiotherapy, targeted therapy, and immunotherapy still needs further exploration.

Laparoscopic management of symptomatic urachus remnants in adults: A retrospective study

Aim

To report our experience in the laparoscopic management of symptomatic urachal remnants (URs) in adults.

Patients and Methods

A retrospective study included all patients who underwent laparoscopic excision of URs during the period January 2015-January 2020. The following data were retrieved from the files of the patients: demographic data, clinical presentations, intra-operative findings, the procedure performed, operative details, intraoperative or post-operative complications and follow-up period mentioned in the files for those patients.

Results

The study included 10 patients (four males and six females) with a mean age of 27.8 ± 11.0 years. URs were discovered preoperatively in all patients except one patient who was diagnosed intraoperatively. URs were associated with other pathologies in four patients (40%) that required two simultaneous surgical procedures. Eight patients (80%) presented with simple umbilical discharge and were diagnosed easily by ultrasonography. All patients were managed successfully with laparoscopic excision and umbilical sparing technique. Excision of the dome of the bladder was done on the selective approach to one patient. No patients showed early post-operative complications. Only one patient had stitch sinus 6 months postoperatively due to a concomitant hernia repair rather than due to the excision of the URs.

Conclusions

Laparoscopic excision of symptomatic urachus is a feasible procedure even when the excision of the bladder is required. It could be performed successfully with other pathologies. It is associated with a low incidence of complications. Laparoscopy allows good visualisation and complete excision that leads to almost no recurrence rate.

Preoperative imaging contributes to pathologically complete resection of the urachal remnant by determining an appropriate surgical approach without unnecessary and excessive surgical invasion: a retrospective study

BACKGROUND

The urachus is an embryonic structure that connects the bladder to the allantois during early embryonic development. Occasionally, it fails to disappear at birth, leading to a case of urachal remnant (UR). This study aimed to determine whether our policy for selecting an appropriate UR resection approach is valid. We performed preoperative imaging to examine whether UR continued toward the bladder apex. If so, the UR and bladder apex were excised using the trans-umbilical approach, in addition to laparoscopy, if necessary. If preoperative imaging indicated that the UR ended near the umbilicus, the UR from the umbilicus to the duct end was resected. Pathological evaluations were performed to determine the appropriateness of the surgical approach indicated by preoperative imaging.

METHODS

We retrospectively reviewed pediatric patients with UR who underwent surgery between 2015 and 2021. Their background characteristics and surgical outcomes were evaluated.

RESULTS

Twenty patients with UR were included (median age, 7 [interquartile range, 2-10.25] years). UR continued toward the bladder apex in 10 patients and ended near the umbilicus in 10 patients. Urachus tissue at the bladder site was observed when the UR and bladder apex were excised. When UR was resected from the umbilicus to the duct end, urachus tissue was not pathologically detected at the resection margin.

CONCLUSION

Our policy results in complete resection without excessive surgical invasion.

Laparoscopic surgery of urachal remnants in children: 3-center experience and comparison to an open approach

Background

Since the first description by Trondsen in 1993, laparoscopy has become the preferred method of surgery of urachal remnants in children. Some authors call it the “gold standard.” Nonetheless, the comparison with open surgery in the literature is limited to several tens of patients. In this paper, we aim to summarize our experience reporting data of a large group of patients.

Results

We conducted a retrospective analysis of anonymized data from patients who underwent surgical interventions at three clinical centers. A total of 78 boys and 33 girls (M:F 2.36:1) were included in our study. Eighty-seven of them underwent mini-invasive surgery (group 1); 24 were operated in a conventional manner (group 2). The predominant form of the urachal anomaly found was the cyst (58.5%), while an umbilical sinus was present in 47 patients (42.3%), a bladder diverticulum in 7 (6.3%), and a patent urachus in 3 cases (2.7%). The average duration of surgery was 60.7 min (20–192 min) in group 1 and 42.7 min (20–90 min) in group 2; excluding the cases with simultaneous interventions, the average duration was found to be 54.5 and 39.7 min, respectively. Twenty-nine simultaneous operations for associated pathologies were performed in 19 cases (21.8%) in our MIS group, in 8 of them (9.19%) for a preoperatively unknown associated pathology, compared to 4 simultaneous operations performed in 4 patients (16.7%) in the open surgery group. We observed intra-operative complications in 2 cases in Group 1; early postoperative complications included hematuria in 14 cases (16%). The duration of postoperative analgesia was significantly shorter in the MIS group.

Conclusions

Laparoscopic surgery has better cosmetic results and allows for additional diagnostics and simultaneous operations that in turn lead to a shorter duration of postoperative analgesia, but has a longer duration in comparison to an open technique.

Case of Infected Urachal Cyst in an Adult Presenting as an Incarcerated Umbilical Hernia

The urachus is a remnant of the allantois. Failure to obliterate can result in one of four anomalies, urachal cyst being most common. Urachal cysts are relatively rare, especially in adults. This paper presents a patient with an umbilical hernia and a ruptured urachal cyst. A 39-year-old male presented with concern for umbilical hernia, but he also noted drainage. Computed tomography scan showed a urachal cyst and umbilical hernia. The urachal cyst was excised and umbilical hernia closed primarily. The incidence of an urachal cyst is unknown, but persists in roughly 2% of adults. Diagnosis is with ultrasound or CT scan. Management is excision due to risk of urachal carcinoma, which is present in over 50% of specimens. Review of literature did not reveal any other cases of a patient with both an urachal cyst and an umbilical hernia, thus making this case a unique presentation for this condition.