Can deciphering the growth of Meckel's diverticulum help us to decide the resection technique?

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-08-30 DOI:10.3389/fsurg.2024.1421732

Mehmet Can, Malik Ergin, Özkan Okur, Ayşe Demet Payza, Kamer Polatdemir, Akgün Oral

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引用次数: 0

Abstract

IntroductionThe employment of laparoscopic surgical techniques has reignited the debate on managing Meckel's Diverticulum (MD) due to its low complication rates. Nevertheless, concerns have been raised regarding completely removing any potential heterotopic mucosa. Our study aimed to compare surgical approaches in MD and assess the effectiveness of simple diverticulectomy.MethodsBetween 2003 and 2022, 139 patients with MD were retrospectively analysed. The study examined the morphometric measurements of the diverticulum and the location of the heterotopic mucosa in the diverticulum regarding growth and symptoms.ResultsSimple diverticulectomy achieved the lowest postoperative complication rate among excision techniques (p = 0.03). MD's length, diameter, and distance to the ileocecal valve increase linearly with growth in the first three years of life (p = 0.00, p = 0.01, p = 0.00) but not in subsequent years (p = 0.81, p = 0.43, p = 0.21). As the length of the MD increases, the heterotopic mucosa (HM) is displaced distally (p = 0.01). Patients in whom HM reaches the base of the diverticulum always present with bleeding (p = 0.02).DiscussionSimple diverticulectomy is a safe technique for Meckel's diverticulum resection. Meckel's diverticulum continues to grow until the age of 3. With this growth, the heterotopic mucosa is displaced distally and moves away from the base of the diverticulum. Bleeding is the main symptom in patients with HM reaching the base of the diverticulum. In patients with bleeding or younger than three years of age, simple diverticulectomy may not be considered safe.Level of Evidence: III

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解读梅克尔氏憩室的生长过程能否帮助我们决定切除技术？

导言由于并发症发生率低，腹腔镜手术技术的应用再次引发了关于如何处理梅克尔氏憩室（MD）的讨论。尽管如此，人们还是对完全切除任何潜在的异位粘膜表示担忧。我们的研究旨在比较梅克尔氏憩室的手术方法，并评估单纯憩室切除术的有效性。结果在各种切除技术中，单纯憩室切除术的术后并发症发生率最低（P = 0.03）。MD 的长度、直径和到回盲瓣的距离在出生后的前三年随着生长呈线性增长（p = 0.00、p = 0.01、p = 0.00），但在随后几年则没有增长（p = 0.81、p = 0.43、p = 0.21）。随着 MD 长度的增加，异位粘膜（HM）向远端移位（p = 0.01）。讨论简单憩室切除术是一种安全的梅克尔憩室切除技术。随着梅克尔憩室的生长，异位粘膜向远端移位并远离憩室底部。出血是 HM 到达憩室底部的患者的主要症状。对于有出血症状或年龄小于三岁的患者，单纯的憩室切除术可能并不安全：证据等级：III

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.