title: Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report.
abstract: BACKGROUND
  Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex.
  
  
  METHODS
  A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively.
  
  
  CONCLUSIONS
  Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures.
authors.affiliation: Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan. Electronic address: kobayashik-sur@h.u-tokyo.ac.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Department of Diagnostic Pathology, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Iijima
authors.affiliation: Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.
authors.forename: Fuyo
authors.initials: F
authors.lastname: Yoshimi
authors.affiliation: Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Nagai
keywords: Abdominal wall lift; Laparoscopic; Urachal remnant