Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults

Abstract

The traditional surgical approach for removing a symptomatic urachal remnant is via a lower midline laparotomy and infraumbilical incision or a laparoscopic approach with umbilicoplasty. We reviewed our experience with umbilicus-sparing laparoscopic urachal remnant excision in a single-center study and evaluated its efficacy versus open approach (OA). This study was a retrospective study. Between March 2012 and September 2016, 32 consecutive patients with symptomatic urachal remnants underwent the umbilicus-sparing laparoscopic approach (USLA) (n = 17) or OA (n = 15). The efficacy, recovery, and long-term outcomes were reviewed. Our Results showed that the clinical characteristics of the patients in each group, such as age, gender, body mass index (BMI), and disease type, had no significant differences (P > .05). No significant difference was found in the surgical procedure times (76.1 ± 15.4 vs 69.2 ± 13.9 minutes, P = .189) and intraoperative blood loss (29.4 ± 13.3 vs 32.2 ± 12.9 mL, P = .543) between the USLA groups and OA groups. However, the mean postoperative hospital stay (patients with bladder cuff excision: 4.1 ± 1.8 vs 6.1 ± 1.4 days, P = .040 and patients without bladder cuff excision: 1.8 ± 0.5 vs 3.6 ± 0.8 days, P < .001) and the time of full recovery (11.2 ± 1.9 vs 15.6 ± 3.1 days, P < .001), the USLA group were both significantly shorter than that of the OA group. No infected recurrence and malignant transformation had occurred at a mean follow-up of 32.4 ± 8.1 and 34.1 ± 8.8 months in USLA group and OA group, respectively. In conclusion, to minimize the morbidity of radical excision, umbilicus-sparing management of benign urachal remnants in adults is a safe and efficacious alternative with superior cosmetic outcomes, postoperative recovery compared with an OA or umbilicoplasty.

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

“…Laparoscopic excision of the UR was rst reported in 1992 [14]. Since then, several modi ed laparoscopic surgery techniques for UR have been developed and reported, with similar surgical outcomes and good cosmetic appearance [3,4]. There are several laparoscopic UR excision methods in terms of port placement, arrangements, and bladder suturing; however, we adopted the LATU approach for excising UR.…”

“…Several studies have evaluated the operative time, cosmetic appearance, and surgical outcomes of the TU approach and LATU approach for UR excision [3][4][5]. However, no studies have discussed whether an appropriate approach to UR excision was determined using preoperative imaging and con rmed by pathological ndings.…”

Preoperative imaging contributes to pathologically complete resection of the urachal remnant by determining an appropriate surgical approach without unnecessary and excessive surgical invasion: a retrospective study

“…The laparoscopic excision of UR has been first reported in 1992 [ 14 ]. Several modified laparoscopic surgery techniques for UR have been developed and reported, with similar surgical outcomes and good cosmetic appearance [ 3 , 4 ]. There are several laparoscopic UR excision methods in terms of port placement, arrangements, and bladder suturing; however, we adopted the LATU approach for excising UR.…”

“…Several studies have evaluated the operative time, cosmetic appearance, and surgical outcomes of the TU and LATU approaches for UR excision [ 3 – 5 ]. However, no studies have discussed whether an appropriate approach to UR excision can be determined using preoperative imaging and confirmed by pathological findings.…”

Case of Infected Urachal Cyst in an Adult Presenting as an Incarcerated Umbilical Hernia

“…An urachal cyst is usually asymptomatic and often found incidentally, though they can be associated with minor complications, including infection or drainage from the umbilicus and malignancy. 1-4…”