Application Of Transumbilical Approach In Meckel's Diverticulum Resection In Infants

OBJECTIVE: Meckel' s diverticulum is one of the most common congenital anomalies of the gastrointestinal tract, affecting 2% of the general population. Most patients with a Meckel' s diverticulum remain asymptomatic. Clinical symptoms arise from complications. The most common complications are hemorrhage from peptic ulceration, small bowel obstruction and diverticulitis, etc. ECT imaging has high sensitivity and specificity in diagnosing Meckel' s diverticulum and can be used preferably in children with gastrointestinal bleeding. The main methods of surgical operation treatment are the traditional laparotomy and laparoscopic operation. But the shortcomings of the traditional laparotomy are more severe trauma and apparent scar. Although laparoscopic operation have the characteristics of microtrauma and fine apparence, the more expense due to using the special apparatus and the more risk of operational complications due to establishing aeroperitoneum are existed. We recommend a minimally invasive, cosmetic and economical operation by transumbilical approach for Meckel' s diverticulectomy. And compared with the traditional abdominal procedure and laparoscopic procedure, to investigate the feasibility of Meckel' s diverticulum resection in infants through unbilical region.METHOD: A total of 33 infants were treated during March 1998 to November 2006. Their main clinical symptom was bleeding of lower digestive tract. ^99mTc imaging was performed on them before operation. All of them were suspected of Meckel' s diverticulum. 33 patients were divided into three groups. 17 patients were operated with traditional laparotomy. 5 patients were performed under laparoscope. And 11 patients were operated through umbilicus. We recorded the significant data during surgery and after surgery, which includes the time of operation, the blood loss during operation, the time of abrosia after operation and the hospital day (HOD) aftet operation. And the data is analysed by statistical analysis method.RESULT: All patients were diagnosed as Meckel' s diverticulum by pathology. There were no significant difference of the time of operation between traditional laparotomy (77.94±19.13 min) and transumbilical laparotomy (75.45±13.50 min) . They both had a significant difference with laparoscopic operation (106.00±11.94 min) . There were no significant difference of the blood loss in operation among the three groups (traditional laparotomy 8.53±6.06 ml, laparoscopic operation 4.60±0.89 ml, transumbilical laparotomy 6.18±2. 52 ml) . There were no significant difference of the time of abrosia after operation and the hospital day after operation between transumbilical laparotomy (2.27±0.47 d, 6.82 ± 0.40 d) and laparoscopic operation (2.20 ± 0.45 d, 6. 60±0. 55 d) . They both had a significant difference with traditional laparotomy (3. 06 ± 0. 66 d, 8.06±1.34 d) in the two aspects.CONCLUSION: The pediateic patients with digestive tract hemorrhage who are diagnosed as Meckel' s diverticulum by ECT imaging can be operated by transumbilical approach. Transumbilical laparotomy is a safe, minimally invasive, economical, feasible procedure with excellent esthetic results.