title: The current strategy for urachal remnants.
abstract: BACKGROUND
  Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR.
  
  
  METHODS
  A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome.
  
  
  RESULTS
  We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59%), a urachal cyst in 5 (18%) and a urachal duct in 6 (22%). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (n = 6, 54%). Group B was dominated by abdominal pain (n = 12, 75%). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA, n = 7) rather than the classical umbilical approach (UA, n = 13). The operation time was not significantly different (LA = 124 min: UA = 110 min, P > 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA.
  
  
  CONCLUSIONS
  Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.
authors.affiliation: Department of Pediatric Surgery, St. Marianna University Yokohama City Seibu Hospital, 1197-1, Yasashi-cho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan, s-hideaki@marianna-u.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Sato
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Furuta
authors.forename: Shiho
authors.initials: S
authors.lastname: Tsuji
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kawase
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitagawa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014496:Urachal Cyst / Q000601:surgery*; D014497:Urachus / Q000601:surgery*