Laparoscopic surgery of urachal remnants in children: 3-center experience and comparison to an open approach

Background
Since the first description by Trondsen in 1993, laparoscopy has become the preferred method of surgery of urachal remnants in children. Some authors call it the “gold standard.” Nonetheless, the comparison with open surgery in the literature is limited to several tens of patients. In this paper, we aim to summarize our experience reporting data of a large group of patients.
Results
We conducted a retrospective analysis of anonymized data from patients who underwent surgical interventions at three clinical centers. A total of 78 boys and 33 girls (M:F 2.36:1) were included in our study. Eighty-seven of them underwent mini-invasive surgery (group 1); 24 were operated in a conventional manner (group 2). The predominant form of the urachal anomaly found was the cyst (58.5%), while an umbilical sinus was present in 47 patients (42.3%), a bladder diverticulum in 7 (6.3%), and a patent urachus in 3 cases (2.7%). The average duration of surgery was 60.7 min (20–192 min) in group 1 and 42.7 min (20–90 min) in group 2; excluding the cases with simultaneous interventions, the average duration was found to be 54.5 and 39.7 min, respectively. Twenty-nine simultaneous operations for associated pathologies were performed in 19 cases (21.8%) in our MIS group, in 8 of them (9.19%) for a preoperatively unknown associated pathology, compared to 4 simultaneous operations performed in 4 patients (16.7%) in the open surgery group. We observed intra-operative complications in 2 cases in Group 1; early postoperative complications included hematuria in 14 cases (16%). The duration of postoperative analgesia was significantly shorter in the MIS group.
Conclusions
Laparoscopic surgery has better cosmetic results and allows for additional diagnostics and simultaneous operations that in turn lead to a shorter duration of postoperative analgesia, but has a longer duration in comparison to an open technique.