Surgical management of Meckel's diverticulum. An epidemiologic, population-based study
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J J Cullen1, K A Kelly, C R Moir
1Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Objective:
The authors determined whether Meckel's diverticulum, discovered incidentally at operation, should be removed.
Summary Background Data:
It is not clear from the medical literature whether the risk of an incidental Meckel's diverticulectomy is greater than the risk of leaving the diverticulum in place.
Methods:
The authors used the medical experience of Olmsted County, Minnesota residents for the period 1950 to 1992 to answer the question.
Results:
During the period, 58 residents developed Meckel's complications that required diverticulectomies. The incidence of complications was 87 per 100,000 person-years, and the lifetime risk (to 80 years of age) of developing them was 6.4%. The risks were similar throughout the period and at all ages of life, but were greater among men (124 per 100,000 person-years) than women (50 per 100,000 person-years, p < 0.05). Diverticulectomies for complications carried an operative mortality and morbidity of 2% and 12% and a cumulative risk of long-term postoperative complications of 7%, whereas incidental diverticulectomies done in 87 residents during the period carried corresponding rates of only 1%, 2%, and 2%, respectively.
Conclusions:
Meckel's diverticula discovered incidentally at operation should be removed for most patients, regardless of age.
Insights
Removing incidentally discovered Meckel's diverticulum is recommended. While complications are rare, the risks associated with incidental removal are significantly lower than those of treating symptomatic Meckel's diverticulum.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Epidemiology
Background:
- The management of incidentally discovered Meckel's diverticulum remains controversial.
- Existing medical literature lacks clarity on whether the risks of incidental diverticulectomy outweigh those of leaving the diverticulum in situ.
Purpose of the Study:
- To determine the appropriate management strategy for Meckel's diverticulum found incidentally during surgery.
- To compare the risks associated with incidental Meckel's diverticulectomy versus conservative management.
Main Methods:
- Retrospective analysis of medical records from Olmsted County, Minnesota residents.
- Data collection spanned from 1950 to 1992.
- Inclusion criteria focused on Meckel's diverticulum complications and incidental diverticulectomies.
Main Results:
- A total of 58 Meckel's diverticulum complications requiring diverticulectomy were recorded.
- The incidence of Meckel's complications was 87 per 100,000 person-years, with a lifetime risk of 6.4% by age 80.
- Incidental diverticulectomies demonstrated significantly lower operative mortality (1% vs. 2%), morbidity (2% vs. 12%), and long-term complication rates (2% vs. 7%) compared to diverticulectomies for complications.
Conclusions:
- Meckel's diverticula discovered incidentally during surgery should generally be removed.
- This recommendation applies to most patients, irrespective of their age.
- The lower risk profile of incidental diverticulectomy supports its routine performance.