RESUMO
BACKGROUND: Meckel's Diverticulum (MD) is a common congenital anomaly accounting for half of pediatric gastrointestinal bleeds. No large-scale studies exist comparing open and laparoscopic surgery and conversion rates remain high. We sought to compare postoperative outcomes associated with each approach and to determine risk factors for conversion. MATERIALS AND METHODS: NSQIP-Pediatric was used to identify patients who underwent a MD resection from 2012 to 2018. Outcomes between patients treated with a laparoscopic versus open versus laparoscopic converted to open (LCO) surgery were compared. Chi-square tests and adjusted logistic regression analysis were used to determine significance and factors associated with conversion. RESULTS: Six hundred eighty-one patients were identified, 295 (43.3%) underwent open, 267 (39.2%) laparoscopic, and 119 (17.5%) LCO resection. Patients undergoing laparoscopic compared to open procedures had shorter length of stay (LOS; 3 versus 4, P= 0.009), and similar morbidities (10.5% versus 16.6%, P= 0.164) and operative times (71.6 versus 76.6 mins, P= 0.449) on adjusted analysis. Patients with LCO compared to open procedures had similar LOS (4 versus 4, P= 0.334) and morbidities (14.3% versus 16.6%, P= 0.358), but longer operative times (90.1 versus 76.6 mins, P= 0.002) on adjusted analysis. Patients with laparoscopic and LCO procedures had fewer unplanned intubations compared to open procedures (0.0% versus 0.0% versus 2.4%, P= 0.011) and lower mortality (0.0% versus 0.0% versus 1.7%, P= 0.046) on univariate analysis. CONCLUSIONS: Laparoscopic MD resection has shorter LOS and similar complications and operative time compared to an open approach while LCO resection increases operative time but not LOS or morbidities.
Assuntos
Conversão para Cirurgia Aberta/estatística & dados numéricos , Laparoscopia/efeitos adversos , Divertículo Ileal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Divertículo Ileal/mortalidade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Masculino , Divertículo Ileal/mortalidade , Divertículo Ileal/patologia , Anormalidade Torcional/complicações , Anormalidade Torcional/metabolismo , Gangrena/sangue , Gangrena/metabolismo , Leucócitos/citologia , Leucócitos/patologia , Tomografia/instrumentação , Divertículo Ileal/complicações , Divertículo Ileal/genética , Anormalidade Torcional/genética , Anormalidade Torcional/terapia , Gangrena/patologia , Gangrena/psicologia , Leucócitos/metabolismo , Leucócitos , TomografiaRESUMO
El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. La mayoría de veces se encuentra en forma incidental durante una laparotomía, o bien, en una autopsia. Cuando preseta síntomas (en aproximadamente un 4 por ciento de los casos) estos suelen ser secundarios a la presencia de mucosa gástrica ectópica, que puede producir ulceraciones, hemorragia y perforación, procesos inflamatorios o bien obstrucción intestinal, como en el cso que se presenta. Descriptores: Abdomen agudo, vólvulo intestinal, divertículo de Meckel.
Assuntos
Humanos , Masculino , Adulto , Divertículo Ileal/diagnóstico , Divertículo Ileal/mortalidade , Divertículo Ileal/terapia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/terapia , Costa RicaAssuntos
Divertículo Ileal/patologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Divertículo Ileal/mortalidade , Divertículo Ileal/cirurgiaRESUMO
In spite of the fact that Meckel's diverticulum is the most common congenital abnormality of the small bowel, there is considerable controversy concerning its surgical management. Resection of a symptomatic Meckel's diverticulum is not a common operation in the experience of most general surgeons. As illustrated by the cases presented in this series, the indications for operation are usually clear. Should abdominal exploration routinely include a search for a Meckel's diverticulum and should it be resected in the absence of symptoms? Although there is no compelling evidence to support the opinion that an asymptomatic Meckel's diverticulum constitutes a major threat to the future well-being of a patient, it is apparent that incidental removal is associated with minimal risk of complications. What are the medicolegal implications? A series of 13 patients is presented to review the salient features of this interesting anomaly, together with pertinent comments from the literature.
