A case of laparoscopic excision of patent urachus

Patent urachus is an uncommon congenital anomaly caused by persistence of embryologic communication between bladder and umbilicus. The traditional surgical approach has been open for years but laparoscopic approach has become an effective and minimal invasive technique to treat urachal remnants. A 11 years old child presenting as umbilical discharge was diagnosed with patent urachus and treated by laparoscopic excision. There was no intra or postoperative complications. Patient was discharged on post-operative day 1. The urachus connects the fetal allantois at umbilicus to the dome of bladder. Normally it obliterates and gives rise to median umbilical ligament. Urachus is extraperitoneal and easily viewed during laparoscopic visualization of pelvis. Urachal remnants represent a rare congenital anomaly due to failure in obliteration process. Complete excision is indicated both in case of persistent symptomatic remnants and also when asymptomatic for the associated risk of malignant degeneration. The traditional approach has been open surgery. However, it is associated with increased morbidity and longer convalescence. Reporting our experience, we describe the technique step by step of laparoscopic patent urachus excision as minimally invasive diagnostic and surgical approach in comparison to open surgical approach, with better post-operative analgesia, rapid healing and cosmetic results.

Infected Urachal Remnants with Symtoms of the Acute Abdomen: The Differential Diagnosis & Proper Management

PURPOSE: Urachal anomalies are rare, but often give rise to a number of problems, such as infection, rupture, sepsis and malignant change. The abdominal manifestation of urachal remnants often prompts referral to general or urologic surgeons. Herein, our clinical experiences were analyzed and guide lines for the preoperative diagnosis and proper management of complicated urachal anomalies suggested. METHODS: Twelve cases of urachal cyst, who visited the surgery department of Pochon CHA university hospital between April 1, 1995 and December 10, 2002, were studied. Clinical data, including clinical manifestations, diagnostic modalities and treatment methods were reviewed. RESULTS: Of the twelve cases reviewed, nine were males and three were females with a mean age of 33.6 years. The most common clinical manifestation was abdominal pain (58%), followed by a palpable mass (25%). The accuracies of the diagnostic modalities were 60 and 37% for abdominopelvic computed tomography and abdominal ultrasonography, respectively. The preoperative diagnosis rate was 50%, with one case not even diagnosed during surgery. CONCLUSION: Persistent urachal remnants can present at any age, with a variety of clinical manifestations. Abdominal computed tomography is a reliable diagnostic tool, and additional diagnostic studies are not generally warranted. The early surgical treatment seems to be the best solution prior to the onset of complications that would expose patients to difficult surgical operations and protract hospitalization.