Laparoscopy Assisted Management of Urachal Anomalies In Children; A Relief for The Surgeon and the Patient?

Anomalies of the urachus constitute a challenge for the physcian and a source of anxiety for the parents. As the significance of the condition and borders between normal and abnormal are not clear, management is controversial. Although not universal, common indications for surgery are presence of symptoms (infection, pain etc) and fear of malignant transformation. Materials And Methods The children who underwent a laparoscopic surgery for a condition related to urachal remnants between 2007 and 2019 are enrolled in the study. Demographics of the patients, intraoperative complications and histological results were retrospectively evaluated and surgical procedure is described. Results A total 13 patients were included in the study. Seven patients had urachal cyst (53%),3 had urachal sinus (23%), 1 patent urachus (8%), 1 omphalomesenteric band remnant (8%) and could not be classified in 1 (8%). Three ports were employed in 6 patients, 4 ports in 4 and 1 port in 2 and 2 ports in 1.Peritoneal contamination could not be avoided in 1 patient with infected urachal cyst during the operation, but postoperative course was uneventful in this patient. Conclusion Although surgical excision is the most commonly recommended management modality for urachal remnants, both parents and physicians hesitate due to the mysterious nature and insufficient data about the long term consequences of the condition. Choosing the best incision is also an issue and physicians may regret for any of the incisions as they may be ‘too extensive’ or ‘insufficient’. Laparoscopic approach provides satisfactory identification of the condition, superior exposure and cosmesis, and at the worst scenario, a chance to select the most appropriate incision.