Laparoscopic management of urachal remnants in children

Objective To evaluate the efficacy and approach of laparoscopic excision of urachal remnants in children. Methods From May 2012 to April 2018, retrospective reviews were conducted for medical records of all children undergoing laparoscopic excision of urachal remnants. Results There were 10 boys and 5 girls with a median age of 4.5(0.3-16.8) years. Umbilicus-sparing laparoscopic urachal excision was performed. The causes were urachal cyst (n=11) and patent urachus (n=4). Complete excision (n=11) and conversion into open surgery & partial cystectomy (n=4) were performed. Postoperative antibiotics were offered. All diagnoses were confirmed by pathological examinations. During a follow-up period of 3-60 months, there was no onset of re-infection or cyst recurrence. Conclusions Umbilicus-sparing laparoscopy is both safe and effective for treating persistent or infected urachus. It offers superior cosmetic outcomes. Partial cystectomy depends upon the presence of an adherent communicating urachal cyst attached to bladder dome. For acute infection, antibiotic dosing or initial incision & drainage with delayed cyst excision may be adopted for avoiding unnecessary complications. Key words: Urachus; Therapeutic laparoscopy; Child