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Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review

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Abstract

Recent reports have recommended laparoscopic diverticulectomy for symptomatic Meckel diverticulum (MD) rather than laparoscopic-assisted extracorporeal resection. This technique may risk leaving residual ectopic mucosa leading to complications. This systematic review attempts to quantify the relative risks of both approaches. A systematic review was conducted according to PRISMA guidelines. Articles were eligible for inclusion if they reported data on the laparoscopic management of symptomatic MD in children. Eleven reports were identified, all of which were institutional retrospective studies. Pooled outcome data on 248 children showed no statistically significant difference in complications between laparoscopic diverticulectomy (n = 133) and laparoscopic-assisted segmental resection (n = 115) (3% vs. 6.1%, p = 0.39). One patient from the diverticulectomy group re-presented with recurrent bleeding necessitating segmental small bowel resection. Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of < 2; diverticula with thickening or ischemia at the base and those complicated by volvulus or small bowel obstruction are probably best treated by laparoscopic-assisted extracorporeal resection. For other symptomatic diverticula laparoscopic diverticulectomy is a reasonable approach with a less than 1% risk of leaving residual ectopic gastric mucosa.

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References

  1. Sagar J, Kumar V, Shah DK (2006) Meckel’s diverticulum: a systematic review. J R Soc Med 99(10):501–505. https://doi.org/10.1177/014107680609901011

    Article  PubMed  PubMed Central  Google Scholar 

  2. Passarge E, Stevenson R (2006) Meckel’s diverticulum. In: Stevenson RE, Hall JE (eds) Human malformations and related anomalies, 2nd edn. Oxford University Press, Oxford

    Google Scholar 

  3. Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005) Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950–2002). Ann Surg 241(3):529

    Article  Google Scholar 

  4. Glenn IC, El-Shafy IA, Bruns NE, Muenks EP, Duran YK, Hill JA, Peter SDS, Prince JM, Lipskar AM, Ponsky TA (2018) Simple diverticulectomy is adequate for management of bleeding Meckel diverticulum. Pediatr Surg Int 34(4):451–455. https://doi.org/10.1007/s00383-018-4239-z

    Article  PubMed  Google Scholar 

  5. Robinson JR, Correa H, Brinkman AS, Lovvorn HN 3rd (2017) Optimizing surgical resection of the bleeding Meckel diverticulum in children. J Pediatr Surg 52(10):1610–1615. https://doi.org/10.1016/j.jpedsurg.2017.03.047

    Article  PubMed  PubMed Central  Google Scholar 

  6. Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV, Kavalakat AJ (2008) Laparoscopic management of symptomatic Meckel’s diverticula: a simple tangential stapler excision. Jsls 12(1):66–70

    PubMed  PubMed Central  Google Scholar 

  7. Varcoe RL, Wong SW, Taylor CF, Newstead GL (2004) Diverticulectomy is inadequate treatment for short Meckel’s diverticulum with heterotopic mucosa. ANZ J Surg 74(10):869–872

    Article  Google Scholar 

  8. Chan KW, Lee KH, Wong HY, Tsui SY, Wong YS, Pang KY, Mou JW, Tam YH (2014) Laparoscopic excision of Meckel’s diverticulum in children: what is the current evidence? World J Gastroenterol 20(41):15158–15162. https://doi.org/10.3748/wjg.v20.i41.15158

    Article  PubMed  PubMed Central  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman D, Group TP, Oxman A, Cook D, Guyatt G, Swingler G, Volmink J, Ioannidis J, Young C, Horton R et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med Public Lib Sci 6:e1000097

    Article  Google Scholar 

  10. Lee KH, Yeung CK, Tam YH, Ng WT, Yip KF (2000) Laparascopy for definitive diagnosis and treatment of gastrointestinal bleeding of obscure origin in children. J Pediatr Surg 35(9):1291–1293. https://doi.org/10.1053/jpsu.2000.9299

    Article  CAS  PubMed  Google Scholar 

  11. Shalaby RY, Soliman SM, Fawy M, Samaha A (2005) Laparoscopic management of Meckel’s diverticulum in children. J Pediatr Surg 40(3):562–567. https://doi.org/10.1016/j.jpedsurg.2004.11.032

    Article  PubMed  Google Scholar 

  12. Cobellis G, Cruccetti A, Mastroianni L, Amici G, Martino A (2007) One-trocar transumbilical laparoscopic-assisted management of Meckel’s diverticulum in children. J Laparoendosc Adv Surg Tech A 17(2):238–241. https://doi.org/10.1089/lap.2006.0036

    Article  PubMed  Google Scholar 

  13. Prasad STR, Chui CH, Singaporewalla FR, Ong CP, Low Y, Yap TL, Jacobsen AS (2007) Meckel’s diverticular complications in children: is laparoscopy the order of the day? Pediatr Surg Int 23(2):141–147. https://doi.org/10.1007/s00383-006-1844-z

    Article  Google Scholar 

  14. Chan KW, Lee KH, Mou JW, Cheung ST, Tam YH (2008) Laparoscopic management of complicated Meckel’s diverticulum in children: a 10-year review. Surg Endosc 22(6):1509–1512. https://doi.org/10.1007/s00464-008-9832-0

    Article  CAS  PubMed  Google Scholar 

  15. Alemayehu H, Stringel G, Lo IJ, Golden J, Pandya S, McBride W, Muensterer O (2014) Laparoscopy and complicated Meckel diverticulum in children. Jsls. https://doi.org/10.4293/jsls.2014.00015

    Article  PubMed  PubMed Central  Google Scholar 

  16. Duan X, Ye G, Bian H, Yang J, Zheng K, Liang C, Sun X, Yan X, Yang H, Wang X (2015) Laparoscopic vs. laparoscopically assisted management of Meckel’s diverticulum in children. Int J Clin Exp Med 8(1):94

    PubMed  PubMed Central  Google Scholar 

  17. Papparella A, Nino F, Noviello C, Marte A, Parmeggiani P, Martino A, Cobellis G (2014) Laparoscopic approach to Meckel’s diverticulum. World J Gastroenterol 20(25):8173–8178. https://doi.org/10.3748/wjg.v20.i25.8173

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mukai M, Takamatsu H, Noguchi H, Fukushige T, Tahara H, Kaji T (2002) Does the external appearance of a Meckel’s diverticulum assist in choice of the laparoscopic procedure? Pediatr Surg Int 18(4):231–233. https://doi.org/10.1007/s003830100663

    Article  PubMed  Google Scholar 

  19. Chen Q, Gao Z, Zhang L, Zhang Y, Pan T, Cai D, Xiong Q, Shu Q, Qian Y (2018) Multifaceted behavior of Meckel’s diverticulum in children. J Pediatr Surg 53(4):676–681. https://doi.org/10.1016/j.jpedsurg.2017.11.059

    Article  PubMed  Google Scholar 

  20. Teitelbaum DH, Polley TZ Jr, Obeid F (1994) Laparoscopic diagnosis and excision of Meckel’s diverticulum. J Pediatr Surg 29(4):495–497

    Article  CAS  Google Scholar 

  21. Blouhos K, Boulas KA, Tsalis K, Barettas N, Paraskeva A, Kariotis I, Keskinis C, Hatzigeorgiadis A (2018) Meckel’s diverticulum in adults: surgical concerns. Front Surg 5:55

    Article  Google Scholar 

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No grant was received in relation to this research from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Paediatric Surgery, Level 3 CSB, Wellington Children’s Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand

    E. P. Redman, P. R. Mishra & M. D. Stringer

  2. Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, 6021, New Zealand

    M. D. Stringer

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  1. E. P. Redman
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  2. P. R. Mishra
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  3. M. D. Stringer
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Correspondence to M. D. Stringer.

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Redman, E.P., Mishra, P.R. & Stringer, M.D. Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review. Pediatr Surg Int 36, 869–874 (2020). https://doi.org/10.1007/s00383-020-04673-5

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