Laparoscopic excision of urachal remnants is a safe and effective alternative to open surgery in children.
BACKGROUND
An infected urachal remnant is an uncommon benign condition that usually recurs and has the potential to become malignant. This study aimed to review our experience in laparoscopic excision of urachal remnants and report the efficacy and outcomes of the procedure in children.


METHODS
Between January 2010 and January 2012, five children with a median age of 35 months presented with urachal remnants at our institute. The data and treatment outcomes of all the patients were retrospectively reviewed. Laparoscopic surgery was performed using three ports, including the umbilical port. In all five children, the urachal remnant was excised from the umbilicus to the bladder dome by electrocauterization, and the stump on the bladder was ligated with endoloop sutures and some absorbable sutures.


RESULTS
All the five procedures were completed successfully. The median pneumoperitoneum time was 75 minutes. The boundary between the normal bladder wall and the urachal remnant was clearly identified using a laparoscope, allowing excision of the remnant and muscle layer of the bladder wall. No intraoperative or postoperative complications were reported at a median follow-up of 16 months. Complete resection of the urachal remnant was confirmed by pathological evaluation. No symptom recurrences were encountered. Laparoscopic resection had good cosmetic outcomes.


CONCLUSIONS
Laparoscopic resection of urachal remnants in children allows for better anatomical visualization and may be considered as a safer, more effective, and more cosmetically beneficial alternative to open surgery.
1 Department of Pediatric Surgery, Saitama Children's Medical Center , Saitama, Japan .
Takayuki
T
Masuko
Hiroo
H
Uchida
Hiroshi
H
Kawashima
Yujiro
Y
Tanaka
Kyoichi
K
Deie
Tadashi
T
Iwanaka
D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011027:Pneumoperitoneum; D011183:Postoperative Complications; D012189:Retrospective Studies; D013537:Sutures; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D014497:Urachus / Q000601:surgery*