Umbilical resection during laparoscopic surgery for urachal remnants.

INTRODUCTION: Because urachal remnants are rare, no standard therapeutic guidelines have been established for this lesion. In recent years, laparoscopic surgery (LS) has been performed by many surgeons and urologists to treat urachal remnants. The prevention of postoperative umbilical infection and late malignant transformation are major issues in the treatment of urachal remnants. Adequate resection of the urachal epithelial tissue is required, and therefore, umbilical resection (UR) is performed. We retrospectively assessed the feasibility of this modality for urachal remnants by examining cases we have experienced as well as 210 Japanese surgical cases found through literature review.

METHODS: From January 1998 to March 2016, we experienced 14 operative cases of urachal remnants who underwent LS at Shimane Prefectural Central Hospital. We examined the types of urachal remnants and patients' ages, symptoms, surgical methods, and pathological findings.

RESULTS: We performed UR in 6 of these 14 LS patients to achieve appropriate resection of the urachal epithelial tissue. The main indication for UR was a long history of preoperative therapies for umbilical infection. The average observation period after the operation was 3.95 years, and no patients developed recurrent umbilical infection or cancer. No patients complained about the aesthetic outcome after umbilicoplasty.

CONCLUSION: We recommend that UR with LS be performed for urachal remnants to prevent any recurrent umbilical infection or malignant transformation in the future.