Management of incidentally diagnosed Meckel's diverticulum in pediatric patients: a questionnaire survey and a literature review.

INTRODUCTION

The presence of Meckel's diverticulum is an indication for its surgical removal. However, the procedure for treating incidentally found Meckel's diverticulum is controversial. Is its resection tangential to the intestinal wall using, for example, a surgical stapler sufficient? Should wedge/segmental intestinal resection with end-to-end anastomosis be performed? Is primary diverticulectomy always safe, or should the procedure be postponed and classified as an elective?

AIM: The objective of the study was to assess the management of incidentally found Meckel's diverticulum based on a questionnaire survey and a literature review.

MATERIAL AND

METHODS

A questionnaire survey was sent to pediatric surgeons in Poland. It included 10 questions about steps taken upon the incidental finding of Meckel's diverticulum during appendectomy and the methods of its treatment. The literature review involved searching PubMed. The analysis included 45 articles published in English.

RESULTS

Eighty-six responses were obtained. Sixty-three (61.63%) respondents stated they look for Meckel's diverticulum during each appendectomy. When Meckel's diverticulum is found, 50 (58.14%) respondents excise it during the primary surgery, but in the case of peritonitis symptoms, only 15 (17.44%) respondents choose to remove it. Meckel's diverticulum with a narrow base is excised by wedge or segmental resection by 50 (58.14%) respondents, with a tangential excision with suture closure of the base performed by 35 (40.70%) respondents. According to 76 (88.37%) respondents, Meckel's diverticulum with a wide base is primarily removed by wedge or segmental resection. 21 (24.42%) respondents stated they have heard of complications associated with non-radical Meckel's diverticulum excision and 6 (6.98%) respondents have encountered them in person. Of these 6 cases, 5 involved bleeding from residual ectopic gastric tissue, and 1 case developed symptoms of acute pancreatitis from residual pancreatic tissue.

CONCLUSIONS

There is a lack of consensus regarding the management of incidentally diagnosed MD. The decision to proceed with an excision is predicated on the clinical situation. Based on our questionnaire survey, tangential resection is mostly used for long MD with a narrow base. For short MD with a wide base, a safer method seems to be a wedge or rectum section of the intestine. The distinction between the methods results from a high probability of ectopic tissue for MD with a wide base. Postoperative complications occur infrequently, considering all the various operative techniques in use.