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

Naoki Hashizume,Eriko Ohta,Daisuke Yamai,Satoshi Suzuki,Kaito Sato,Tetsuya Shimada,Kouei Nihei,Kaoru Sakamoto,Yasuhiro Shirahata,Minoru Yagi,Akihiro Takeshi,Masahiro Ohtaki

doi:10.1186/s40792-020-00884-z

Naoki Hashizume, Eriko Ohta + Show 10 more

Open Access

https://doi.org/10.1186/s40792-020-00884-z

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Abstract

BackgroundVarious 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 presentationFrom 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.ConclusionsAlthough 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.

Highlights

Urachal remnants occasionally require intervention when they become infected and symptomatic [1, 2]
Patients Seven patients of 10 to 15 years of age with a urachal remnant were treated by laparoscopic surgery from January 2015 to December 2019
After the cephalic side of the urachus and the medial umbilical ligaments were dropped into the abdominal cavity, an intraperitoneal wound retractor (Lap Protector®, Hakko Medical, Nagano, Japan) was placed in the open umbilicus

Summary

Introduction

Urachal remnants occasionally require intervention when they become infected and symptomatic [1, 2]. Surgical procedures All patients were resected urachal remnant and the medial umbilical ligaments. After the cephalic side of the urachus and the medial umbilical ligaments were dropped into the abdominal cavity, an intraperitoneal wound retractor (Lap Protector®, Hakko Medical, Nagano, Japan) was placed in the open umbilicus. A wound retractor separated the dropped cephalic side of the urachus and the medial umbilical ligaments (Fig. 2a). Any bowel or omental adhesions from prior operations or inflammatory reactions of the infected urachal remnant and medial umbilical ligaments were lysed off using ultrasonic scissors (Fig. 2b). A single ENDOLOOP ligature® (ETHICON; Bridgewater, NJ, USA) was placed at the caudal stump of the medial umbilical ligaments, which was tied and transected with ultrasonic scissors (Fig. 2c). The clinical results of the laparoscopic excision of urachal remnants and medial umbilical ligaments, the perioperative records, and the pathologic results were evaluated. We found no postoperative complications, including recurrence of symptoms in patients with or without infection and intestinal obstruction for adhesion formation

Discussion

Conclusion

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