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Concomitant resection of Meckel diverticulum during laparoscopic appendectomy: Retrospective propensity-matched ACS-NSQIP study and a case report
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作者 Sean Huu-Tien Nguyen matthew wheelwright +3 位作者 Victor Vakayil Pravin Meshram Ryan O’Donnell James Vail Harmon 《World Journal of Gastrointestinal Surgery》 2025年第5期355-362,共8页
BACKGROUND The surgical management of incidentally detected Meckel diverticulum(MD)during appendectomy remains controversial.We present a case report alongside an analysis of the ACS-NSQIP database to evaluate postope... BACKGROUND The surgical management of incidentally detected Meckel diverticulum(MD)during appendectomy remains controversial.We present a case report alongside an analysis of the ACS-NSQIP database to evaluate postoperative outcomes associated with concomitant Meckel diverticulectomy during laparoscopic appen-dectomy.CASE SUMMARY We report the case of a 34 year-old woman presenting with acute appendicitis and an incidentally detected MD.The patient presented to the emergency department with right lower quadrant pain.Computed tomography revealed acute appen-dicitis with possible contained perforation.During laparoscopic operative ma-nagement of her appendicitis,an incidental MD was noted and resected via a stapled diverticulectomy.She was discharged on the same day as her surgery without complication.Postoperative pathology examination revealed an MD without acute pathology.To review outcomes associated with performing in-cidental Meckel diverticulectomy during laparoscopic appendectomy,an ad-ditional 12-year retrospective ACS-NSQIP analysis was performed.To compare between laparoscopic appendectomy alone and Meckel diverticulectomy with appendectomy(MA),propensity matching was employed.MA was associated with a significantly increased operative time and longer hospital stays.However,no significant differences in 30-day mortality or postoperative outcomes were observed between the groups.Core Tip:Incidental Meckel diverticulum(MD)is rare but can be encountered during routine abdominal surgical procedures.The surgical management of incidental MD remains debated.We report a case of resection of an incidentally detected MD during laparoscopic appendectomy with no complications on the 6-year follow-up.ACS-NSQIP analysis demonstrated that concurrent incidental Meckel diverticulectomy with laparoscopic appendectomy does not increase morbidity and mortality.However,Meckel diverticulectomy with laparoscopic appendectomy increases resource utilization.We recommend resection on the basis of individualized patient’s factors and acknowledge that incidental Meckel diverticulectomy can be efficiently and safely performed in selected patients.INTRODUCTION Surgical resection of an incidentally detected Meckel diverticulum(MD)during appendectomy for acute appendicitis remains controversial.We present a case report and analyzed the ACS-NSQIP database to examine postoperative complications and patient outcomes associated with concomitant Meckel diverticulectomy during appendectomy.Although generally asymptomatic,MD can present with painless bleeding,diverticulitis,perforation,bowel obstruction,intussusception,fistula,and neoplasm[1-3].Two of the most common symptoms in children include bleeding and obstruction,whereas in up to 58%of adults with symptomatic MD,Meckel diverticulitis is reported to be the presenting feature[4].Mechanical obstruction,volvulus,and intestinal strangulation may result from intussusception due to MD[5].Moreover,MD may present with symptoms indicative of enterocyst or intestinal–umbilical fistula[6].A consensus that complicated and symptomatic MD should be resected exists;however,whether incidentally detected asymptomatic MD should be resected remains unclear.Risk scoring systems to resect asymptomatic MD have been described however there are few registry database analyses analyzing incidental MD resection outcomes[6].We here compared postoperative complications and patient outcomes associated with concomitant Meckel diverticulectomy during primary laparoscopic appendectomy compared with laparoscopic appendectomy alone(AA).rovsing sign was elicited.The extremities were warm to touch and well perfused.TREATMENT The patient proceeded to the operating room for standard laparoscopic appendectomy.Intraoperatively,the tip of the appendix was distended and inflamed.A contained perforation was revealed.The base of the appendix,which was grossly normal,was divided using a laparoscopic stapler.The mesoappendix was divided using a LigaSure©energy device.The appendix was removed and placed in an Endocatch bag.A protrusion from the small bowel was noted extending along the antimesenteric side of the ileum consistent with an MD.A diverticulum was laparoscopically palpated and contained a firm mass.To decrease the risk of future complications and owing to the described firmness,the diverticulum was removed.Using a laparoscopic stapler,diverticulectomy was performed in a longitudinal manner parallel to the long axis of the bowel on the antimesenteric surface.The MD was removed from the abdomen and placed in an Endocatch pouch.The procedure was completed,and the patient was subsequently taken to the post anesthesia care unit. 展开更多
关键词 ACS-NSQIP NSQIP Meckel diverticulum Meckel diverticulectomy Appendectomy Appendicitis Case report
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