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[Meckel's diverticulum. Pro and co routine removal]
1Chirurgischen Abteilung, des a.ö. Krankenhauses Melk.
Abstract:
The following points are made against the background of experience recorded by the author from 115 cases of Meckel's diverticulum: Active intra-operative search for Meckel's diverticulum continues to be justified in the course of all operations in which such search appears to be practicable without traumatisation of the intestine due to the given surgical access route and which would not imply the risk of germ transmission. It is, of course, necessary to remove any macroscopically changed Meckel's diverticulum. Removal of the macroscopically inconspicuous Meckel's diverticulum is recommended, as well, since grave microscopic pathology may be concealed under the surface and because possible damage would be clearly outweighed by the benefit achieved from removal of an even macroscopically inconspicuous Meckel's diverticulum. Any Meckel's diverticulum accidentally discovered in a patient in somewhat advanced age should be removed, since the author's own experience against reports by other authors is likely to suggest that the rate of diverticular complications is relatively high in advanced age groups. It is absolutely imperative to look for Meckel's diverticulum in all cases in which intra-operative findings are in disagreement with clinical examinations prior to surgery, particularly in cases in which signs of acute appendicitis were pre-operatively recorded, whereas bland appendix was found on surgery.
Insights
Active surgical exploration for Meckel's diverticulum is recommended during abdominal surgeries when feasible. Removal is advised for all identified cases, even those appearing normal, to prevent potential complications.
Area of Science:
- Gastroenterology
- Surgical Pathology
Context:
- Meckel's diverticulum is a congenital anomaly of the small intestine.
- Diagnosis can be challenging, with potential for significant pathology.
- Experience from 115 cases informs surgical decision-making.
Purpose:
- To evaluate the indications and benefits of intra-operative Meckel's diverticulum detection and removal.
- To assess the risk-benefit ratio of excising asymptomatic versus symptomatic diverticula.
- To emphasize the importance of Meckel's diverticulum screening in specific surgical scenarios.
Summary:
- Intra-operative search for Meckel's diverticulum is justified if surgically feasible and safe.
- Removal of macroscopically abnormal diverticula is essential.
- Excision of macroscopically normal Meckel's diverticula is recommended due to potential hidden pathology and high benefit-risk ratio.
- Removal is particularly advised in older patients and when intra-operative findings contradict preoperative clinical assessments, such as in suspected appendicitis with a normal appendix.
Impact:
- Improved patient outcomes through proactive identification and management of Meckel's diverticulum.
- Reduced incidence of complications associated with undiagnosed Meckel's diverticulum.
- Enhanced surgical decision-making protocols for intra-abdominal procedures.