Single-Incision Laparoscopic Surgery in Diagnosis and Treatment for Gastrointestinal Bleeding of Obscure Origin in Children

Abstract

In this multimedia manuscript with video presentation, we reported our experience of performing single-incision laparoscopic surgery (SILS) on 3 children who presented with gastrointestinal bleeding from congenital small bowel lesions. Preoperative investigations including endoscopy and technetium scintigraphy were all negative in the 3 patients aged 4, 7, and 10 years, respectively. SILS was performed using reusable 3- and 5-mm ports and standard straight instruments. The small bowel lesions were located by SILS and the bowel segment with the pathology was exteriorized through the umbilical wound for extracorporeal resection. The diagnoses of the 3 children were Meckel's diverticulum, ileal duplication cyst, and multiple small bowel vascular malformations. All the 3 children recovered uneventfully from surgery without any complications and required minimal postoperative analgesia. Our experience suggested that SILS is an effective alternative to conventional laparoscopy in both diagnostic and therapeutic functions for children with gastrointestinal bleeding of obscure origin.

Clinical outcomes of minimally invasive surgery for Meckel diverticulum: a multicenter study

“…Although we analyzed the medical records of patients treated at 6 hospitals, the number of patients may be too small to reach a definitive conclusion. Nevertheless, we included more patients than previous studies [4][5][6][7][10][11][12][13][14][15][17][18][19][20]. It must also be highlighted that the low incidence of MD precludes a prospective randomized trial.…”

“…It was first described by Johann Friedrich Meckel in 1808 and is also termed omphalomesenteric duct fistula, cyst, or sinus [ 2 3 ]. Although it is found incidentally during abdominal surgery for other pathologies, it can be associated with several complications, including congenital hernia, intestinal bleeding, bowel obstruction due to intussusception or fibrous band, and panperitonitis due to MD perforation [ 4 5 6 7 ].…”

“…Conventional surgical treatment of MD has involved exploratory laparotomy with simple diverticulectomy, wedge resection, or small bowel resection and anastomosis [ 8 9 ]. With recent advances in laparoscopic techniques, minimally invasive surgery (MIS) has been applied for the treatment (i.e., resection) of MD in several studies [ 4 5 6 7 10 11 12 13 14 15 16 17 18 19 20 ]. These studies revealed that laparoscopic resection of MD is safe and feasible.…”

Obstructive internal hernia caused by mesodiverticular bands in children

“…[ 19 ] Recently, single incision laparoscopic surgery (SILS) has emerged as a new technique in minimally invasive surgery, but limited numbers of reports on SILS in MD management in children are available. [ 20 , 21 ] As is the usual practice in our Department, the MD in our second case was laparoscopically individuated and excised using a laparoscopic-assisted technique.…”

Secondary involvement of Meckel’s diverticulum by group A β-hemolytic streptococcus in a child with upper airways infection treated by laparoscopic-assisted resection

“…Recently, single incision laparoscopic surgery (SILS) has emerged as a new technique in minimally invasive surgery, but limited numbers of reports on single incision laparoscopic surgery in the management MD were available [12].…”