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Published on: November 30, 2010
National trends in the surgical management of Meckel's diverticulum
Kimberly A Ruscher1, James N Fisher, Christopher D Hughes
1Department of Pediatric Surgery, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford, CT 06106, USA.
Insights
Laparoscopic surgery for Meckel's diverticulum (MD) in children reduces hospital stays compared to open surgery. However, the open approach remains more common for treating symptomatic MD.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Current Meckel's diverticulum (MD) treatment guidelines lack robust evidence, relying on limited single-institution data.
- This study utilizes national database information to analyze surgical management and outcomes for pediatric Meckel's diverticulectomy.
Purpose of the Study:
- To review current surgical practices for Meckel's diverticulum in children.
- To compare outcomes between open and laparoscopic approaches for symptomatic Meckel's diverticulectomy.
Main Methods:
- Analysis of 2007-2008 data from the Pediatric Health Information System database.
- Classification of Meckel's diverticulum cases into primary (symptomatic) and secondary (incidental).
- Comparison of outcomes for primary cases based on surgical approach (open vs. laparoscopic).
Main Results:
- 815 pediatric Meckel's diverticulectomies were performed; 60% were primary cases.
- Common presentations for primary MD included obstruction (30%), bleeding (27%), and intussusception (19%).
- Laparoscopic surgery was associated with a shorter length of stay (4.3 days) compared to open surgery (5.7 days) in primary cases (P < .02).
Conclusions:
- This study provides insights into contemporary trends in pediatric Meckel's diverticulum surgical treatment in the U.S.
- Laparoscopic Meckel's diverticulectomy demonstrates a shorter hospital stay but is underutilized compared to open laparotomy.
Background:
Treatment recommendations for Meckel's diverticulum (MD) come mostly from single-institution case series. The objective of this study was to review the surgical management and outcomes of children undergoing Meckel's diverticulectomy using contemporary data from a national database.
Methods:
We queried 2007 to 2008 data from the Pediatric Health Information System database and analyzed demographic and outcome variables for patients undergoing surgical resection of MD. Cases were classified as primary (symptomatic MD) or secondary (incidental MD). Outcomes in primary cases were compared between open and laparoscopic approaches. Statistical analyses were performed using SPSS (Chicago, IL).
Results:
Eight hundred fifteen children underwent Meckel's diverticulectomy. Meckel's diverticulectomy was more common in boys (boy-girl, 2.3:1), and half (53%) of the children required surgery before their fourth birthday. More cases (n = 485; 60%) were classified as primary, and most children were approached by laparotomy (75%). The most common presentations for primary cases were obstruction (30%), bleeding (27%), and intussusception (19%). In the primary group, patients treated with the laparoscopic approach had a shorter length of stay (open approach, 5.7 ± 5.2 days; laparoscopic approach, 4.3 ± 2.7 days; P < .02).
Conclusion:
These data describe current trends in the surgical treatment of MD in the United States. Laparoscopic Meckel's diverticulectomy appears to shorten length of stay but is used much less frequently than the traditional open approach.
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