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Outcomes of laparoscopic resection of Meckel's diverticulum are equivalent to open laparotomy
Brian Ezekian1, Harold J Leraas2, Brian R Englum1
1Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Purpose:
Meckel's diverticulum (MD) is a common congenital anomaly caused by failure of involution of the omphalomesenteric duct. Enthusiasm for minimally invasive surgery (MIS) in children has burgeoned as technologies have advanced, but the outcomes of laparoscopic resection in comparison to open laparotomy for MD remain poorly defined. We queried a large national database to compare current practice patterns and clinical outcomes between surgical approaches for MD in the pediatric population.
Methods:
The National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) database was queried for patients undergoing surgical intervention for MD (2011-2014). Patients were stratified by surgical approach. Baseline characteristics, intraoperative variables, and perioperative complications were compared by univariate analysis using Pearson's χ2 test for categorical variables and Kruskall-Wallis test for continuous variables. Primary outcomes of interest were length of stay (LOS), rate of readmission, and 30-day mortality. Secondary outcomes included operative time, anesthesia time, postoperative complications, and rates of reoperation.
Results:
A total of 148 cases of MD were identified, of which 73 (49.3%) were initially managed with a laparoscopic approach and 75 (50.7%) were managed with an open approach. We found a high rate of conversion from laparoscopy to an open approach (20/73 or 27.4%). The median age of the laparoscopic group was higher than the open group (8.3 vs. 2.5years, p<0.001). Operative and anesthesia time, LOS, 30-day mortality, post-operative complications, and rates of reoperation and readmission were similar between groups (all p>0.05).
Conclusion:
Nearly half of all resections for MD in children are now approached laparoscopically. This approach has equivalent outcomes to traditional open laparotomy. More widespread use of a hybrid approach with laparoscopy and exteriorization of the small bowel through an extended port site may facilitate avoiding open laparotomy. Routine conversion to open for palpation of the MD or segmental small bowel resection should be avoided in the absence of compelling intra-operative findings or operative complications.
Level Of Evidence:
Level III (retrospective comparative study).
Insights
Laparoscopic surgery for Meckel's diverticulum (MD) in children shows similar outcomes to open surgery. Minimally invasive techniques are effective, and routine conversion to open procedures should be avoided unless necessary.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Congenital anomalies
Background:
- Meckel's diverticulum (MD) is a common congenital anomaly.
- Minimally invasive surgery (MIS) is increasingly used in pediatric surgery.
- Outcomes of laparoscopic vs. open MD resection in children are not well-defined.
Purpose of the Study:
- Compare practice patterns and clinical outcomes of laparoscopic versus open surgical approaches for MD in pediatric patients.
- Evaluate the effectiveness and safety of MIS for MD in children.
Main Methods:
- Retrospective comparative study using the National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) database (2011-2014).
- Compared baseline characteristics, intraoperative variables, and perioperative complications between laparoscopic and open surgical groups.
- Analyzed outcomes including length of stay, readmission rates, 30-day mortality, operative time, and complications.
Main Results:
- 148 pediatric MD cases were analyzed; 49.3% underwent laparoscopy, 50.7% underwent open surgery.
- A significant conversion rate (27.4%) from laparoscopy to open surgery was observed.
- Laparoscopic and open approaches demonstrated similar outcomes regarding length of stay, readmission, mortality, and complications.
Conclusions:
- Laparoscopic resection is a viable option for pediatric Meckel's diverticulum with comparable outcomes to open laparotomy.
- Consideration of hybrid approaches may further reduce open conversions.
- Avoid routine conversion to open surgery for simple palpation or resection without compelling intraoperative findings.