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ORIGINAL ARTICLE
Laparoscopy-assisted Approach for Meckel’s Diverticulum in

Pediatric Age

1
2
Hesham M Kassem , Mohamed Alekrashi , Wael Elshahat 3
AbstrAct
Background: Meckel’s diverticulum (MD) is the most common congenital gastrointestinal tract (GIT) anomaly, with incidence approximately
2–4%. It is usually asymptomatic and it is usually discovered accidentally during laparotomy or presenting with complication as perforation,
bleeding, and bowel obstruction. The surgical treatment of MD includes exploratory laparotomy with either diverticulectomy or segmental
small bowel resection.
Materials and methods: A retrospective review performed for the cases of MD operated by laparoscopy-assistedexcision of the diverticulum in
Zagazig University Hospital and International Medical Center Jeddah, during the period from November 2012 to October 2018, all data regarding
patients’ demographics, clinical features, diagnostic tests performed, histopathology reports, operative time, conversion to laparotomy, hospital
stay, and complications were analyzed.
Results: This study includes 17 patients with MD who underwent laparoscopy-assisted excision of MD. The median age of the patients was
8.3 years. The male to female ratio was 11:6. Lower GIT bleeding was the most common presenting symptom. All patients were subjected to a
laparoscopy-assisted excision. Four patients underwent wedge excision and 13 patients underwent segmental bowel resection.
Conclusion: Laparoscopy-assisted resection of MD is safe, simple, and inexpensive. Moreover, it avoids the risk of intra-abdominal contamination.
Keywords: Bleeding per rectum, Children, Laparoscopy, Meckel’s diverticulum.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1408

IntroductIon 1–3 Pediatric Surgery Department, Faculty of Medicine, Zagazig
Meckel’s diverticulum (MD) is one of the most common congenital University, Egypt
anomaly of the gastrointestinal tract (GIT), with incidence Corresponding Author: Hesham M Kassem, Pediatric Surgery
approximately 2–4%. 1,2 Department, Faculty of Medicine, Zagazig University, Egypt, Phone:
It arises from remnants of the omphalomesenteric duct, which +20 9665470074301, e-mail: kassemhesham91@yahoo.com
connects the midgut to the yolk sac in the fetus, and usually How to cite this article: Kassem HM, Alekrashi M, Alshahat W.
undergoes complete involution between the fifth and sixth weeks Laparoscopy-assisted Approach for Meckel’s Diverticulum in Pediatric
of gestation as the bowel return back normal anatomical position. 3 Age. World J Lap Surg 2020;13(2):65–68.

Meckel’s diverticulum mostly is asymptomatic and it is Source of support: Nil
usually an incidental finding when laparotomy is performed Conflict of interest: None
for other abdominal conditions but can be presented by
intestinal obstruction, intussusception, gastrointestinal bleeding,
diverticulitis, or perforation. 4 a 5 mm port for the camera was placed through the umbilicus using
Surgical treatment of MD involves laparotomy with either open technique. Another two 5 mm working ports were placed,
diverticulectomy or segmental small bowel resection. Recently, one in the suprapubic region and one in the left iliac fossa, after
some authors have described the use of laparoscopy as minimally creation of pneumoperitoneum with an insufflation of 0.5 L/minute
invasive for the resection of MD. 5,6 to a maximum pressure of 10–12 mm Hg. Exploration of the small
intestine was performed by 2 a traumatic grasper to identify the MD.

MAterIAls And Methods The MD was dissected from the mesentery and was grasped
with a traumatic forceps passed through the umbilicus (Figs 1 and 2).
A retrospective review was performed for the cases of MD treated The umbilical incision was extended and the diverticulum was
surgically by laparoscopy-assisted excision of the diverticulum brought out from the umbilicus. We perform wedge resection in
in Zagazig University Hospital and International Medical Center case of long diverticulum and narrow base but in case of short
Jeddah between January 2010 and December 2017. diverticulum and broad base we performed bowel resection and
All of the following data were collected and analyzed: patients’ anastomosis, in one case, the resection was performed using a linear
demographics, clinical features, investigations, histopathology stapler device, the anastomosed bowel was returned back into the
reports, operative time, any operative or postoperative abdomen, and the umbilical wound was closed.
complications, and duration of hospital stay.
Operative Procedure results
Laparoscopy-assisted excision of MD was performed through three This study includes 17 patients with MD who underwent
or two ports. After general anesthesia with endotracheal intubation, laparoscopy-assisted excision of MD. The median age of the patients

© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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