Preoperative imaging is essential for pathologically complete resection of the urachal remnant without unnecessary and excessive surgical invasion 

Abstract

Background We aimed to determine whether our policy of selecting the appropriate urachal remnant (UR) resection approach is valid. We performed preoperative imaging to examine whether the UR continued toward the bladder apex. If the UR continued toward the bladder apex, then we excised the UR and bladder apex using the trans-umbilical approach adding laparoscopy in needed. If preoperative imaging indicated that the UR ended near the umbilicus, then we resected the UR from the umbilicus to the duct end. Pathological evaluations were performed to determine the appropriateness of the surgical approach indicated by preoperative imaging. Methods We retrospectively reviewed pediatric UR patients who underwent surgery between 2015 and 2021. Their background characteristics and surgical outcomes were evaluated. Results Twenty UR patients were evaluated (median age, 7 years; range, 8 days-12 years). The UR continued toward the bladder apex in 10 patients and ended near the umbilicus in 10 patients. Urachus tissue at the bladder site was observed when the UR and bladder apex were excised. When the UR was resected from the umbilicus to the duct end, urachus tissue was not pathologically detected at the resection margin. Conclusions Our policy leads to complete resection without excessive surgical invasion.