Meckel's diverticulectomy: laparoscopic approach and critical analysis of the technique

Meckel’s diverticulum is a true diverticulum that normally obliterates in the 7-8 weeks of gestation; however, its incidence ranges between 2-3%. It is difficult to diagnose during both clinical and imaging examination because the symptoms and imaging features are non-specific. We present the stepwise laparoscopic approach for a Meckel’s diverticulectomy.

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Meckel's diverticulectomy: laparoscopic approach and critical analysis of the technique

Authors

D Varela, D Mutter, J Marescaux

Abstract

Meckel’s diverticulum is a true diverticulum that normally obliterates in the 7-8 weeks of gestation; however, its incidence ranges between 2-3%. It is difficult to diagnose during both clinical and imaging examination because the symptoms and imaging features are non-specific. We present the stepwise laparoscopic approach for a Meckel’s diverticulectomy.

Classification

clinical cases

Keywords

Meckel\'s diverticulectomy, laparoscopy

Media type

Surgical video

Duration

03'10''

Publication

2008-12

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E-publication

WeBSurg.com, Dec 2008;8(12).
URL: http://www.websurg.com/doi-vd01en2439.htm

Meckel's diverticulectomy: laparoscopic approach and critical analysis of the technique

1. Clinical case presentation 00'10''

We report the case of a 45-year-old patient admitted to hospital for acute abdominal pain. The initial diagnostic suspicion was appendicitis but the blood test was negative. A CT-scan was performed, which showed a bowel intussuception, with a big inflammation of the parietal wall of the small intestine. We decided to perform a laparoscopic exploration.

2. Exploration 00'42''

The appendix was seen immediately but showed no sign of inflammation. The bowel was examined extensively.

3. Meckel\'s diverticulum 00'52''

At about 30cm of the ileocecal junction, it showed a typical Meckel’s diverticulum with no major signs of inflammation. A complete evaluation showed a distal inflammation of this Meckel’s diverticulum.

4. Diverticulum resection 01'14''

It was decided to perform a small bowel longitudinal resection. This is not an accurate decision, in fact the application of the GIA longitudinally can cause post-operative stenosis of the small bowel. GIA has to be applied transversally. The diverticulum was completely resected with the application of the GIA and was placed immediately in an intra-abdominal bag in order to avoid abdominal contamination.

5. Appendectomy 01'53''

As usual, we decided to perform a systematic appendectomy. The appendix is exposed, the appendicular vessels are coagulated with the bipolar coagulation and the stump of the appendix is freed with monopolar coagulation. Surgitie is used classically to perform the ligation of the base of the appendix. Ideally, this stump is controlled with a single ligation. A second stitch is applied distally one centimetre away from the first one in order to have the possibility to cut the appendix without any contamination of the abdominal cavity. After section of the appendix, the specimen is placed in bag. Both specimens are retrieved together from the abdominal cavity.