Page 14 - Journal of Laparoscopic Surgery

10.5005/jp-journals-10007-1132
REVIEW ARTICLE
Morvendhran Moodley
Current Laparoscopic Management of

Symptomatic Meckel’s Diverticulum

Morvendhran Moodley
Specialist Surgeon, RK Khan Hospital, Durban, South Africa

ABSTRACT

Laparoscopic management is currently becoming an acceptable technique in the management of complicated Meckel’s diverticulum. The
study reviews the current techniques described in numerous series since over the past 10 years. Three laparoscopic techniques are
described namely; LAMD (Laparoscopic-assisted Meckel’s diverticulectomy—3 port technique with exteriorization of the diverticulum
via the umbilical port and extracorporeal diverticulectomy), VATMD (Video-assisted Meckel’s diverticulectomy—single umbilical port
using operating laparoscope) and LMD(Laparoscopic Meckel’s diverticulectomy—3 port technique with intracorporeal diverticulectomy).
Small study sizes make in-depth statistical analysis impossible. Patient outcome with each technique however, seems similar, suggesting
that the ultimate choice of procedure should be left to surgeon and institutional preference. The high incidence of heterotropic gastric
mucosa (HGM) in complicated Meckel’s diverticulum is confirmed and calculated to be an average of 78.2%.
Keywords: Meckel’s diverticulum, Laparoscopic management, Complication.

INTRODUCTION • Intestinal obstruction
Meckel’s diverticulum is a rare congenital abnormality of the • Nonspecific abdominal pain.
midgut widely accepted to occur in approximately 2% of the Intestinal obstruction may occur as a result of:
general population. The embryological and anatomic description • Volvulus of the small bowel around the fibrous band of the
of this anomaly was first published by Johann Friedrich Meckel diverticulum
in 1809 and as such it now carries his name. Meckel’s • Luminal fibrosis and stenosis secondary to recurrent or
diverticulum is a true diverticulum, containing all layers of the chronic diverticulitis, or
intestinal wall, and represents a failure of complete obliteration • Intussusception.
of the embryonic omphalomesenteric duct, and is usually Conventional surgical management has been laparotomy and
present on the antimesenteric border of the distal ileum within any of:
approximately 100 cm of the ileocecal valve. It is also a common • Simple diverticulectomy
site for heterotopic mucosa, most frequently gastric although • Diverticulectomy with wedge excision of adjacent ileum
heterotopic, colonic and pancreatic tissues are not infrequently • Segmental ileal resection and anastomosis.
reported within the diverticulum. There are two commonly performed laparoscopic
The majority of cases are asymptomatic and may often be procedures for Meckel’s diverticulum. The ‘conventional’
discovered incidentally. Even in symptomatic patients, procedure is a 3 port laparoscopy, identification of the
preoperative diagnosis is often difficult. Clinically, there is as diverticulum and either intracorporeal diverticulectomy using
yet no consensus as to the precise management of endoscopic linear stapler-cutting device or exteriorization of
asymptomatic diverticula, since the risk of postoperative the diverticulum through the enlarged umbilical port site and
complications may still be as high as 8%. Surgical excision, subsequent extracorporeal excision of the diverticulum and repair
however, would still seem appropriate in those cases where of the enteric defect as appropriate. A more novel approach
patient profile and diverticulum morphology may increase the involves a single port technique using an operating laparoscope
likelihood of complications later on in life. 1 through the umbilicus—subsequent grasping and exterio-
rization of the diverticulum through the umbilical incision and
Morphological variations include: diverticulectomy.
• Short diverticulum with a wide base
• Long diverticulum with a narrow base AIM
• Short diverticulum with adherent fibrous band to the Aim of this review is to determine whether laparoscopy offers a
umbilicus safe and feasible alternative to conventional surgery, particularly
• Patent vitellointestinal duct in the pediatric population.
• Periumbilical sinus.
METHODS
Clinical presentation in symptomatic patients:
• Anemia/Lower GI bleeding A PubMed search was conducted using the keywords:
• Diverticulitis presenting as an acute abdomen Laparoscopy; Meckel’s diverticulum; children; laparoscopic

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