Number №3, 2020 - page 168-175

Possibilities of laparoscopic access in the surgical reatment of urachusmalformations in children: experience of 9 centers DOI: 10.29188/2222-8543-2020-12-3-168-175

For citation: Shchedrov D.N., Shormanov I.S., Morozov E.V., Kagantsov I.M., Chertyuk V.B., Vladisova D.A., Farkov M.A., Okopny K.N., Polyakov P.N., Kupryakov S.O. Possibilities of laparoscopic access in the surgical reatment of urachus malformations in children: experience of 9 centers. Experimental and clinical urology 2020;(3):168-175.
Schedrov D.N., Shormanov I.S., Morozov E.V., Kagancov I.M., Chertyuk V.B., Vladisova D.A., Farkov M.A., Okopnyy K.N., Polyakov P.N., Kupryakov C.O.
Information about authors:
  • Shchedrov D.N. – head of the department of pediatric urology-andrology, Regional children's clinical hospital, Russia, Yaroslavl, MD,
  • Shormanov I.S. – head of the department of urology with nephrology, Yaroslavl state medical university, MD, professor,
  • Morozov E.V. – doctor, pediatric surgeon, Regional children's clinical hospital, Russia,Yaroslavl,
  • Kagantsov I.M. – head of the Department of Urology, Republican Children's Clinical Hospital, Syktyvkar, MD,
  • Chertyuk V.B. – researcher, department of surgery, Scientific research institute of emergency pediatric surgery and traumatology, Russia, Moscow
  • Vladisova D.A. – doctor, children's surgeon, Kostroma regional children's hospital, Russia, Kostroma
  • Farkov M. A. – doctor, pediatric surgeon, Severodvinsk city children's clinical hospital, Russia, Severodvinsk
  • Okopny K.N. – doctor, pediatric urologist andrologist Children's clinical hospital, Russia, St. Petersburg
  • Polyakov P.N. – doctor, pediatric urologist-andrologist, St. Mary Magdalene Children's Hospital No. 2 of, Russia, St. Petersburg
  • Kupryakov S.O. – head of the department of pediatric uroandrology, Republican hospital No. 1., Russia, Yakutsk

Introduction. Urachus abnormalities are rare in childhood practice. The need for active management of patients with such pathology is due to the significant frequency of its complicated forms and, accordingly, a high risk of their development. Over the past few years, minimally invasive methods of surgical treatment have been actively introduced into the practice of treating diseases of urachus. At the same time, the experience of their application remains relatively insignificant, and the need for them is not supported by serious research using various statistical methods. This creates the prerequisites for clarifying a number of provisions on the indications for a particular method of treatment of patients with anomalies of urachus, which makes this problem extremely urgent today.

Purpose. To conduct a comparative assessment of various methods of surgical treatment of urachus abnormalities in children.

Materials and methods. The experience of managing 80 patients with anomalies of urachus was analyzed. The main treatment methods were laparoscopic excision (n = 30) or removal of urachus by traditional access (n = 28). The indications for each of the methods are analyzed, a comparative analysis of the results is presented.

Results and discussion. The generalized experience of using laparoscopic interventions for various forms of pathology of urachus allowed us to formulate the following points: - the inability to use the primary entrance to the abdominal cavity through the umbilicus; - significant anatomical variability of the object of surgical intervention does not allow to unify access points; - with the zone of interest in the umbilicus (sinus) or slightly lower (fistula, cyst), preference is given to the single-flange arrangement of trocars, providing the widest possible visualization of the entire space between the navel and the bladder and the area of the working instruments; the length and relatively small anatomical width of the formation of urachus under the abdominal wall allows in all cases to distinguish it from one flank; - when accessing the diverticulum of the bladder requires visualization from above and the ability to work with tools on both sides of the top of the bladder; - at high risk of perforation of a tense cyst in case of infection or difficulty in isolating from surrounding tissues due to the periprocess, percutaneous puncture under the control of optics can be used to relieve tension, which facilitates subsequent discharge and prevents infection of the abdominal cavity; - in a comparative analysis of homogeneous groups of patients operated on with laparoscopic and traditional access, the advantages of the first are obvious: fewer relapses, less blood loss, less pronounced pain in the postoperative period, better cosmetic result.

Conclusion. Laparoscopic access today is optimal for the surgical treatment of urachus abnormalities, allowing you to perform any necessary amount of intervention with minimal risk and the most comfortable postoperative period.

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urachus abnormalities, children, treatment, laparoscopy, results.

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