Suprapubic Open and Single-Port Laparoscopic Surgery for Urachal Remnant in Children: A Case Series

Introduction

A narrow operative field, difficult dissection of an inflamed urachal remnant (UR) and possible incomplete resection of UR at the bladder dome may be serious problems in laparoscopic surgery with umbilical and extraperitoneal approaches. To overcome these problems, we recently introduced suprapubic open and single-port laparoscopic surgery (SOSLS) for UR in children.

Materials and Surgical Technique

The root of UR was resected and the bladder wall was closed under direct vision through a 3 cm suprapubic transverse incision. A multichannel port with three trocars was applied to the suprapubic incision, and the laparoscopic dissection proceeded until reaching the cephalic end of UR below the umbilicus, when adhesion to the omentum or intestines, if present, could be dissected. Then an open procedure through a circumumbilical incision completed the resection of the UR, including the bottom of the umbilical skin and part of the linea alba, and the specimen was extracted through the umbilical incision. The two incisions were closed using antiadhesion sheets in the abdominal cavity. Four patients with a UR (median age, 12.5 [range: 9–16] years) received SOSLS in 2021–2024. The median operative time was 193.5 (180–217) minutes and the median blood loss was 5 (1–20) ml. The postoperative course was uneventful, with a median postoperative hospital stay of 3.5 (3–5) days.

Discussion

SOSLS appears to be an easy and effective procedure for treating UR in elder children with a longer umbilicus–bladder distance. It shows satisfactory cosmetic results, taking advantage of both open and laparoscopic procedures.