title: Laparoscopic management of symptomatic urachal remnants in adulthood.
abstract: BACKGROUND
  The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this study is to report our experience with laparoscopic urachus excision as a minimally invasive diagnostic and surgical technique.
  
  
  METHODS
  This study was a prospective study involving patients who were diagnosed with persistent urachus and underwent laparoscopic excision. The morbidity, recovery, and outcomes of surgery were reviewed.
  
  
  RESULTS
  Fourteen patients (8 men) with a mean age of 22.8 ± 6.42 years underwent laparoscopic excision. All patients presented with discharge from the umbilicus. Although four patients had no sonographic evidence of a patent urachus, a diagnostic laparoscopy detected a patent urachus that was excised laparoscopically. One patient required laparoscopic reoperation for persistent discharge, and one patient presented with bladder injury, which was repaired via a small Pfannenstiel incision without any morbidity. The mean operative time was 71.1 ± 0.28 minutes, and the mean duration of hospital stay was 1.3 ± 1.38 days. Pathological examination confirmed a benign urachal remnant in all cases.
  
  
  CONCLUSIONS
  Laparoscopy is a useful alternative for the management of persistent or infected urachus, especially when its presence is clinically suspected despite the lack of sonographic evidence. The procedure is associated with low morbidity, although a small risk of bladder injury exists, particularly in cases of severe active inflammation. Recurrence is uncommon and was caused by inadequate excision of inflammatory tissue in our series that was easily managed laparoscopically.
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia. Electronic address: szeli18@yahoo.com.
authors.forename: Sze Li
authors.initials: SL
authors.lastname: Siow
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia.
authors.forename: Hans Alexander
authors.initials: HA
authors.lastname: Mahendran
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hardin
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014497:Urachus / Q000002:abnormalities* / Q000601:surgery*; D055815:Young Adult
keywords: bladder; laparoscopy; urachal cyst; urachal remnant; urachal sinus; urachus