Laparoscopic excision of the urachus

Embryologically, the urachus represents the obliterated alantois in the form of a fibrous cord extending from the dome of the bladder to the umbilicus. Incomplete obliteration can result in the formation of an umbilical sinus, fistula, cyst, or abscess in the infraumbilical area. The traditional treatment of a residual urachus is surgical resection of the entire tract from the dome of the bladder to the umbilicus through a lower midline incision. We report the case of a 14-year-old girl who presented with an abscess below the umbilicus. After initial drainage, she developed a sinus that communicated with the navel. Surgical resection of the underlying urachus was carried out laparoscopically. The peritoneum was incised at the umbilicus, and the whole tract along with the skin sinus was excised using diathermy scissors. The lower end was ligated and the specimen retrieved. The patient was discharged the following day. One week later, her wounds had healed. Histology confirmed an epithelial-lined urachus. We believe that laparoscopic excision of a patent urachus is feasible and safe. This technique gives the surgeon good access to the area and has a cosmetically better result.