Laparoscopic approach to Meckel's diverticulum.
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.
['Papparella|Alfonso|A|', 'Nino|Fabiano|F|', 'Noviello|Carmine|C|', 'Marte|Antonio|A|', 'Parmeggiani|Pio|P|', 'Martino|Ascanio|A|', 'Cobellis|Giovanni|G|']
D015746:Abdominal Pain D000293:Adolescent D002648:Child D002675:Child, Preschool D005260:Female D006471:Gastrointestinal Hemorrhage D006801:Humans D007223:Infant D007558:Italy D010535:Laparoscopy D007902:Length of Stay D008297:Male D008467:Meckel Diverticulum D061646:Operative Time D012189:Retrospective Studies D013997:Time Factors D016896:Treatment Outcome
Gastrointestinal bleeding Ileal duplication Jejunal hemangioma Laparoscopy Meckel’s diverticulum Minimal invasive surgery One trocar surgery