Laparoscopic Surgery of Symptomatic Urachal Remnants

Takahiro Mizukawa, Norimasa Koide, Takao Kunou, Katsushi Yoshida, Shigemi Onoue, Kenji Katou. Inazawa municipal hospital

Introduction: The traditional approach for removing a symptomatic urachal remnant has been open surgery with a hypogastric transverse or midline infraumbilical incision. Recent minimally invasive laparoscopic techniques can effectively manage this disease. We review our experience with laparoscopic resection of an urachal remnant and report the efficacy and outcomes of this procedure as a less morbid, minimally invasive alternative.

Methods and procedures: Between June 2008 and June 2015, 17 patients (13 males, 4 females) with mean age of 28.2 years (range, from 12 to 43years) were included in this study. Laparoscopic treatment was performed after patient’s acute symptoms subsided.

The visualization port using the Endopath Xcel 5-mm trocar placed on the right hemi abdomen, and was insufflated by using CO2 with intraabdminal pressure maintained at 8mmHg. Another 5-mm port was placed under direct vision on the caudal side of the camera port. .Another 2-mm port or 5-mm port was placed on the head side. The bladder is filled with about 300ml of physiologic solution to help identify the bladder. The urachal remnant was dissected from the umbilicus to the bladder dome, and then removed completely. The caudal side of urachal remnant was ligated with an intracorporeal knot and was transected with ultrasonic scissors, just above the bladder dome. And then, the umbilicus was excised with the umbilical remnant. Finally, we performed umbilicoplasty. Intra and postoperative complications were analyzed to assess the safety and feasibility of the procedure.

Result: As for chief complaint, 16 patients were pyogenic discharge from the umbilicus, and 1 patient was pyuria. The mean day to operation after conservative treatment was 66 days (range, 2 to 262 days). The mean operative time was 167 minutes (range, 78 to 285 minutes). The blood loss was less than 10 ml. There were no conversion to laparotomy. The mean hospital stay was 3.7 days (range, 3 to 9 days). There were no significant intraoperative or postoperative complications except 1 patient having small injury of colonicserosa.

Conclusions: Laparoscopic resection of an urachal remnant was a safe and feasible procedure. This procedure provides satisfactory cosmetic results.