AIM: To retrospective review the laparoscopic management of Meckel Diverticulum(MD) in two Italian Pediatric Surgery Centers.METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted(TU...AIM: To retrospective review the laparoscopic management of Meckel Diverticulum(MD) in two Italian Pediatric Surgery Centers.METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted(TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years(range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was establishedbased on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients' demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed.RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min(range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d(range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years(range 10 mo-10 years).CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel's diverticulectomy is safe and effective in the treatment of MD, with excellent results.展开更多
Complications aroused from Meckel's diverticulum tend to developed in children.Children presented with abdominal pain,intestinal obstruction,intussusception or gastrointestinal bleeding may actually suffered from ...Complications aroused from Meckel's diverticulum tend to developed in children.Children presented with abdominal pain,intestinal obstruction,intussusception or gastrointestinal bleeding may actually suffered from complicated Meckel's diverticulum.With the advancement of minimally invasive surgery(MIS) in children,the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel's diverticulum has gained popularity.Recently,single incision laparoscopic surgery(SILS) has emerged as a new technique in minimally invasive surgery.This review offers the overview in the development of MIS in the management of children suffered from Meckel's diverticulum.The current evidence in different laparoscopic techniques,including conventional laparoscopy,SILS,the use of special laparoscopic instruments,intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel's diverticulum in children were revealed.展开更多
Meckel’s diverticulum is not commonly encountered surgical entity and presents unique challenges for a pediatric surgeon, as it is prone to varied complications. A 14-year-old boy was admitted with us with a 48-hour ...Meckel’s diverticulum is not commonly encountered surgical entity and presents unique challenges for a pediatric surgeon, as it is prone to varied complications. A 14-year-old boy was admitted with us with a 48-hour history of lower abdominal pain and multiple episodes of vomiting. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A fleeting conservative management was tried. The diagnostic laparoscopy revealed a small bowel obstruction secondary to a Meckel’s diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day four, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic means for a patient with a small bowel obstruction due to an uncertain etiology.展开更多
Gallstone ileus due to erosion of one or more gallstones into the gastrointestinal tract is an uncommon cause of small bowel obstruction. The site of impaction is usually distal ileum, and less commonly the jejunum, c...Gallstone ileus due to erosion of one or more gallstones into the gastrointestinal tract is an uncommon cause of small bowel obstruction. The site of impaction is usually distal ileum, and less commonly the jejunum, colon, duodenum, or stomach. We report a rare case of gallstone ileus with impaction at the proximal small bowel and at a Meckel's diverticulum(MD) in a 64-yearold woman managed with laparoscopic converted to open small bowel resections. Patient was discharged home in stable condition and remained asymptomatic at 6-mo follow up. We review the current literature on surgical approaches to MD and gallstone ileus. Diverticulectomy or segmental resection is preferred for complicated MD. For gallstone ileus, simple enterolithotomy or segmental resection are the most the most favored especially in older co-morbid patients due to lower mortality rates and the rarity of recurrent gallstone ileus. In addition, laparoscopy has been increasingly reported as a safe approach to manage gallstone ileus.展开更多
文摘AIM: To retrospective review the laparoscopic management of Meckel Diverticulum(MD) in two Italian Pediatric Surgery Centers.METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted(TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years(range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was establishedbased on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients' demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed.RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min(range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d(range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years(range 10 mo-10 years).CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel's diverticulectomy is safe and effective in the treatment of MD, with excellent results.
基金Supported by The Spanish Ministry of Economy and Competitiveness and by FEDER European Union funds,projects No.AGL2010-14952,No.AGL2010-16525 and No.AGL2012-33278
文摘Complications aroused from Meckel's diverticulum tend to developed in children.Children presented with abdominal pain,intestinal obstruction,intussusception or gastrointestinal bleeding may actually suffered from complicated Meckel's diverticulum.With the advancement of minimally invasive surgery(MIS) in children,the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel's diverticulum has gained popularity.Recently,single incision laparoscopic surgery(SILS) has emerged as a new technique in minimally invasive surgery.This review offers the overview in the development of MIS in the management of children suffered from Meckel's diverticulum.The current evidence in different laparoscopic techniques,including conventional laparoscopy,SILS,the use of special laparoscopic instruments,intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel's diverticulum in children were revealed.
文摘Meckel’s diverticulum is not commonly encountered surgical entity and presents unique challenges for a pediatric surgeon, as it is prone to varied complications. A 14-year-old boy was admitted with us with a 48-hour history of lower abdominal pain and multiple episodes of vomiting. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A fleeting conservative management was tried. The diagnostic laparoscopy revealed a small bowel obstruction secondary to a Meckel’s diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day four, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic means for a patient with a small bowel obstruction due to an uncertain etiology.
文摘Gallstone ileus due to erosion of one or more gallstones into the gastrointestinal tract is an uncommon cause of small bowel obstruction. The site of impaction is usually distal ileum, and less commonly the jejunum, colon, duodenum, or stomach. We report a rare case of gallstone ileus with impaction at the proximal small bowel and at a Meckel's diverticulum(MD) in a 64-yearold woman managed with laparoscopic converted to open small bowel resections. Patient was discharged home in stable condition and remained asymptomatic at 6-mo follow up. We review the current literature on surgical approaches to MD and gallstone ileus. Diverticulectomy or segmental resection is preferred for complicated MD. For gallstone ileus, simple enterolithotomy or segmental resection are the most the most favored especially in older co-morbid patients due to lower mortality rates and the rarity of recurrent gallstone ileus. In addition, laparoscopy has been increasingly reported as a safe approach to manage gallstone ileus.
