Laparoscopic management of urachal remnants in children

Year 2017, Volume: 34 Issue: 2, 89 - 92, 08.09.2017

Gulnur Gollu , Gönül Küçük Ufuk Ates Bilge Türedi Farid Khanmammadov Aydın Yagmurlu Huseyin Dindar Meltem Bingol Kologlu

Abstract

Urachal remnant is an uncommon congenital anomaly which is caused by the

persistence of embryologic communication between the bladder and the umbilicus.

The surgical approach to these remnants has been open for years but

endoscopic surgery has become more popular because of its better cosmetic

results, less postoperative pain and faster returns to daily activities. The aim of

this study is to present 17 cases of urachal remnants that were treated by laparoscopic

excision. Retrospective review was performed included all patients

diagnosed with an urachal remnant (UR) and underwent laparoscopic excision

between January 2009 and January 2015. Patient variables included age, gender,

presenting symptoms, diagnostic modality, type of urachal remnant, operative

time, post-operative complications and follow-up were recorded. Laparoscopic

surgery was performed using three ports. The urachal remnant was excised

starting from the umbilicus to the bladder dome by cauterization. Stump on the

bladder was ligated with endoloop sutures. We identified 17 pediatric patients

with an urachal cyst (n=8), urachal diverticulum (n=4), urachal sinus (n=4) and

patent urachus (n=1). Median age of the patients was 7 years (5 months-17

years). All patients had symptomatic URs. Abdominal pain (n=8), umbilical

discharge (n=6), and umbilical mass (n=3) were presenting symptoms. Ultrasonography

confirmed the diagnosis of urachal remnant in all children. Mean

operating time was 30 minutes (12-60 minutes). No intraoperative or postoperative

complications were reported at a mean follow-up of 28 months. Histopatological

examination revealed benign urachal remnant. Laparoscopic excision

of urachal remnants is a preferable alternative to traditional open surgery with

better postoperative analgesia, cosmetic results and rapid healing. Laparoscopic

approach is an effective and minimal invasive technique to treat of urachal

remnants in children.

Keywords

Children, Laparoscopy, Minimal invasive, Urachal

References

• Bertozzi, M., Riccioni, S., Appignani, A., 2014. Laparoscopic treatment of symptomatic urachal remnants in children. J. Endourol. 28, 1091-1096. doi: 10.1089/end.2014.0203. Chiarenza, S.F., Scarpa, M.G., D’Agostino, S., Fabbro, M.A., Novek, S.J., Musi, L., 2009. Laparoscopic excision of urachal cyst in pediatric age: Report of three cases and review of the literature. J. Laparoendosc. Adv. Surg. Tech. A. 19, 183-186. doi: 10.1089/lap.2008.0184. Cutting, C.W., Hindley, R.G., Poulsen, J., 2005. Laparoscopic management of complicated urachal remnants. BJU Int. 96, 1417- 1421. Fahlenkamp, D., Schönberger, B., Lindeke, A., Loening, S.A., 1995. Laparoscopic excision of the sinusoidal remnants of the urachus in a 3-year-old boy. Br. J. Urol. 76, 135-137. Fanning, D.M., Sabah, M., Conlon, P.J., Mellotte, G.J., Donovan, M.G., Little, D.M, 2011. An unusual case of cancer of the urachal remnant following repair of bladder exstrophy. Ir. J. Med. Sci. 180, 913-915. doi: 10.1007/s11845-009-0310-z. Kojima, Y., Hayashi, Y., Yasui, T., Itoh, Y., Maruyama, T., Kohri, K., 2007. Laparoscopic management for urachal cyst in a 9-yearold boy. Int. Urol. Nephrol. 39, 771-774. Kurtz, M., Masiakos, P.T., 2008. Laparoscopic resection of a urachal remnant. J. Pediatr. Surg. 43, 1753-1754. doi:10.1016/j. jpedsurg.2008.04.021. Masuko, T., Uchida, H., Kawashima, H., Tanaka, Y., Deie, K., Iwanaka, T., 2013. Laparoscopic excision of urachal remnants is a safe and effective alternative to open surgery in children. J. Laparoendosc. Adv. Surg. Tech. A. 23, 1016-1019. doi: 10.1089/ lap.2013.0127. Sato, H., Furuta, S., Tsuji, S., Kawase, H., Kitagawa, H., 2015. The current strategy for urachal remnants. Pediatr. Surg. Int. 31, 581-587. doi: 10.1007/s00383-015-3712-1. Siow, S.L., Mahendran, H.A., Hardin, M., 2015. Laparoscopic management of symptomatic urachal remnants in adulthood. Asian J. Surg. 38, 85-90. doi: 10.1016/j.asjsur.2014.04.009. Trondsen, E., Reiertsen, O., Rosseland, A.R,1993. Laparoscopic excision of urachal sinus. Eur. J. Surg. 159, 127-128. Yohannes, P., Bruno, T., Pathan, M., Baltaro, R., 2003. Laparoscopic radical excision of urachal sinus. J. Endourol. 17, 475-479.