Laparoscopic En-Bloc Excision of Urachal Sinus With Umbilical Ligament Complex in a Pediatric Patient: A Case Report and Review of Literature.

Urachal anomalies are rare congenital disorders, with umbilical-urachal sinus being the least common subtype, accounting for approximately 0.03% of pediatric cases. Complete surgical excision is the standard treatment. While open surgery is traditionally preferred in younger children, laparoscopy is increasingly favored for older pediatric patients due to improved anatomical access and recovery outcomes. However, reports of laparoscopic management from low-resource settings remain limited. A 12-year-old male presented with a 2-week history of purulent umbilical discharge. Imaging via ultrasound and CT sinogram confirmed an umbilical-urachal sinus without bladder communication. Following outpatient antibiotic therapy, the patient underwent laparoscopic en-bloc excision of the umbilical-urachal sinus, including the median and both medial umbilical ligaments. A triangulated left subcostal port configuration was used to complete the dissection. Postoperatively, the patient developed transient sepsis, which resolved with intravenous antibiotics. Histopathology confirmed an infected urachal sinus. At 3-month follow-up, he remained asymptomatic with no recurrence. Laparoscopic excision offers an effective alternative to open surgery, providing optimal anatomical visualization, cosmetic outcomes, and favorable postoperative recovery. Literature supports laparoscopy in older pediatric patients due to the longer bladder-to-umbilicus distance, which permits complete excision through minimally invasive means. This case demonstrates the feasibility of laparoscopic en-bloc excision for umbilical-urachal sinus in an older child, even in a resource-limited setting without the use of advanced energy devices. To our knowledge, this is the first laparoscopic urachal sinus excision reported from Nepal. It highlights the safety, efficacy, and adaptability of minimally invasive techniques in low-resource environments.