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Laparoscopic Treatment of Meckel’s Diverticulum in 24 Children (Abstract)

JC. Gouli, G. Andrianandraina, D. Forgues, MP. Guibal, N. Kalfa, E. Sabatier-Laval, H. Allal, R. B. Galifer.

Department of Visceral Pediatric Surgery and Pediatric Urology

Hospital Montpellier, France

 

Abstract

Background: Laparoscopic assistance is indicated in the management of pediatric abdominal surgical diseases. We report our experience treating Meckel's diverticulum (MD) in the Department of Visceral Pediatric Surgery of the Montpellier University Hospital.

Patients and methods: The records of 24 children hospitalized over a period of 10 years (1997-2007) for lower gastrointestinal bleeding and/or abdominal pain syndrome were reviewed retrospectively. The mean age of the 16 boys and 8 girls was 7.2 years. In 13 cases, MD was diagnosed incidentally during laparoscopy for acute surgical abdomen. All 24 patients underwent laparoscopic-assisted extracorporeal diverticulectomy and intestinal resection. The following preoperative examinations were conducted: ultrasound (n = 24), upper/lower gastrointestinal endoscopy (n = 6). The diagnosis of MD was suspected by ultrasound in 11 cases. In all cases, diverticulectomy with end-to-end anastomosis was performed. All postoperative complications were documented.

Results: The 13 cases of fortuitous discovery presented as acute surgical abdomen. In these cases, the MD was complicated by peritonitis (n = 10; 40%), bowel obstruction (n = 2; 10%) or pseudo-appendicitis syndrome (4%). In 11 other cases, the MD was symptomatic. Six patients presenting massive rectal bleeding with hemoglobin levels below 7g/dl underwent gastroscopy and colonoscopy, without showing the cause of bleeding. Abdominal ultrasound revealed the MD in 11 of the 24 children who had this exam (i.e., 45%).Laparoscopic-assisted extracorporeal resection was performed in all patients: 15 cases (62.5%) by umbilical incision and nine (37.5%) by transverse incision in the right iliac fossa. In our series, resection of the MD plus the involved bowel was performed, with end-to-end anastomosis. Heterotopic gastric mucosa was found in 16 cases (67%). The average length of hospitalization was 7 days. We noted acute pancreatitis as a complication in one patient.

Conclusion: Extracorporeal diverticulectomy with resection of involved bowel is the procedure of choice because it ensures the radical excision of ectopic gastric mucosa. When assisted by laparoscopy, it is safer and less invasive than conventional surgery. Laparoscopy has many advantages, including reduced postoperative pain and more esthetic result.

Key words: Meckel’s diverticulum, extracorporeal diverticulectomy, laparoscopy, child.

 

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