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Published on: February 28, 2025
Outcomes of Laparoscopic Versus Open Resection of Meckel's Diverticulum
Nicholas J Skertich1, Martha-Conley Ingram2, Miles W Grunvald3
1Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, Chicago, Illinois; Department of Surgery, Rush University Medical Center, Chicago, Illinois.
Background:
Meckel's Diverticulum (MD) is a common congenital anomaly accounting for half of pediatric gastrointestinal bleeds. No large-scale studies exist comparing open and laparoscopic surgery and conversion rates remain high. We sought to compare postoperative outcomes associated with each approach and to determine risk factors for conversion.
Materials And Methods:
NSQIP-Pediatric was used to identify patients who underwent a MD resection from 2012 to 2018. Outcomes between patients treated with a laparoscopic versus open versus laparoscopic converted to open (LCO) surgery were compared. Chi-square tests and adjusted logistic regression analysis were used to determine significance and factors associated with conversion.
Results:
Six hundred eighty-one patients were identified, 295 (43.3%) underwent open, 267 (39.2%) laparoscopic, and 119 (17.5%) LCO resection. Patients undergoing laparoscopic compared to open procedures had shorter length of stay (LOS; 3 versus 4, P= 0.009), and similar morbidities (10.5% versus 16.6%, P= 0.164) and operative times (71.6 versus 76.6 mins, P= 0.449) on adjusted analysis. Patients with LCO compared to open procedures had similar LOS (4 versus 4, P= 0.334) and morbidities (14.3% versus 16.6%, P= 0.358), but longer operative times (90.1 versus 76.6 mins, P= 0.002) on adjusted analysis. Patients with laparoscopic and LCO procedures had fewer unplanned intubations compared to open procedures (0.0% versus 0.0% versus 2.4%, P= 0.011) and lower mortality (0.0% versus 0.0% versus 1.7%, P= 0.046) on univariate analysis.
Conclusions:
Laparoscopic MD resection has shorter LOS and similar complications and operative time compared to an open approach while LCO resection increases operative time but not LOS or morbidities.
Insights
Laparoscopic surgery for Meckel's Diverticulum (MD) offers shorter hospital stays with similar outcomes compared to open surgery. Laparoscopic converted to open (LCO) surgery increases operative time but not complications.
Area of Science:
- Pediatric surgery
- Surgical outcomes
- Congenital anomalies
Background:
- Meckel's Diverticulum (MD) is a frequent cause of pediatric gastrointestinal bleeding.
- Existing research lacks large-scale comparisons of open versus laparoscopic MD resection.
- High conversion rates from laparoscopic to open surgery necessitate further investigation.
Purpose of the Study:
- To compare postoperative outcomes between open, laparoscopic, and laparoscopic converted to open (LCO) Meckel's Diverticulum resections.
- To identify risk factors associated with conversion from laparoscopic to open surgery.
Main Methods:
- Utilized the NSQIP-Pediatric database to identify patients undergoing MD resection (2012-2018).
- Compared outcomes for open, laparoscopic, and LCO surgical approaches.
- Employed chi-square tests and adjusted logistic regression for statistical analysis.
Main Results:
- Laparoscopic resection was associated with a shorter length of stay (LOS) compared to open surgery (3 vs. 4 days).
- LCO procedures resulted in longer operative times than open surgery (90.1 vs. 76.6 minutes) but similar LOS and morbidities.
- Laparoscopic and LCO groups showed fewer unplanned intubations and lower mortality compared to open surgery on univariate analysis.
Conclusions:
- Laparoscopic Meckel's Diverticulum resection demonstrates a shorter LOS with comparable complications and operative times to open surgery.
- Conversion to open surgery (LCO) increases operative time without significantly impacting LOS or morbidity.
