A Surgical Technique for Urachal Excision: Transumbilical Extraperitoneal Tunneling

Abstract

Purpose: Recently, the laparoscopic excision of urachal remnants has been conducted at an increasing number of facilities. However, laparoscopic excision may cause postoperative intestinal adhesion due to peritoneal damage during the excision of the urachal remnants. We devised a surgical technique for the excision of urachal remnants, called trans-umbilical extraperitoneal tunneling (TET). By further improvement of TET, we were able to provide superior cosmetic results and minimize peritoneal damage. We hereby report on this technique.

Methods: Twenty-three patients who underwent laparoscopic excision of urachal remnants with TET at our hospital between October 2005 and October 2015 were studied. We retrospectively investigated operative time, intraoperative blood loss, and the postoperative clinical course.

Results: The mean age of patients was 17.9 years (3 months old to 44 years old). There were 13 children and 10 adults, and the male-to-female ratio was 15 to 8. The mean operative time was 101 min, the mean blood loss was 7.3 g, and the mean postoperative hospital stay was 4.4 days. No complications were observed.

Conclusions: TET is an effective surgical technique that provides superior cosmetic results, and can be used to avoid the risk of postoperative intestinal obstruction. The observation of urachal remnants with a laparoscope is effective in preventing unnecessary manipulations. Additionally, tissue traction using a retractor ring can very effectively provide a good surgical view.