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The current strategy for urachal remnants
Background Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR. Ma...
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| Published in: | Pediatric surgery international 2015-06, Vol.31 (6), p.581-587 |
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| container_title | Pediatric surgery international |
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| creator | Sato, Hideaki Furuta, Shigeyuki Tsuji, Shiho Kawase, Hirokazu Kitagawa, Hiroaki |
| description | Background
Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR.
Materials and methods
A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome.
Results
We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59 %), a urachal cyst in 5 (18 %) and a urachal duct in 6 (22 %). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (
n
= 6, 54 %). Group B was dominated by abdominal pain (
n
= 12, 75 %). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA,
n
= 7) rather than the classical umbilical approach (UA,
n
= 13). The operation time was not significantly different (LA = 124 min: UA = 110 min,
P
> 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA.
Conclusion
Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children. |
| doi_str_mv | 10.1007/s00383-015-3712-1 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1681262271</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3683360841</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-1de02b582d50e3dfffdb19367db56015e8914cf952823ce49d9956df47a8ffac3</originalsourceid><addsrcrecordid>eNp1kMtKxDAUhoMozjj6AG6k4EYX0ZykSZOlDN5gwM24Dmkuc6HTjkm78O1t6SgiuDqL853__HwIXQK5A0KK-0QIkwwT4JgVQDEcoSnkrMBKAjtGUwKFwoRxOUFnKW0JIZIJdYomlEslqMqn6Ha59pntYvR1m6U2mtavPrPQxKyLxq5NlUW_q03dpnN0EkyV_MVhztD70-Ny_oIXb8-v84cFtnlOWwzOE1pySR0nnrkQgitBMVG4kou-qZcKchsUp5Iy63PllOLChbwwMgRj2QzdjLn72Hx0PrV6t0nWV5WpfdMlDUICFZQW0KPXf9Bt08W6bzdQRHAlhOopGCkbm5SiD3ofNzsTPzUQPXjUo0fdt9ODRz0kXx2Su3Ln3c_Ft7geoCOQ-lW98vHX639TvwBrEHu-</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1680659669</pqid></control><display><type>article</type><title>The current strategy for urachal remnants</title><source>Springer Nature</source><creator>Sato, Hideaki ; Furuta, Shigeyuki ; Tsuji, Shiho ; Kawase, Hirokazu ; Kitagawa, Hiroaki</creator><creatorcontrib>Sato, Hideaki ; Furuta, Shigeyuki ; Tsuji, Shiho ; Kawase, Hirokazu ; Kitagawa, Hiroaki</creatorcontrib><description>Background
Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR.
Materials and methods
A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome.
Results
We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59 %), a urachal cyst in 5 (18 %) and a urachal duct in 6 (22 %). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (
n
= 6, 54 %). Group B was dominated by abdominal pain (
n
= 12, 75 %). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA,
n
= 7) rather than the classical umbilical approach (UA,
n
= 13). The operation time was not significantly different (LA = 124 min: UA = 110 min,
P
> 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA.
Conclusion
Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.</description><identifier>ISSN: 0179-0358</identifier><identifier>EISSN: 1437-9813</identifier><identifier>DOI: 10.1007/s00383-015-3712-1</identifier><identifier>PMID: 25896294</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Laparoscopy ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Pediatric Surgery ; Pediatrics ; Postoperative Complications - surgery ; Retrospective Studies ; Surgery ; Treatment Outcome ; Urachal Cyst - surgery ; Urachus - surgery</subject><ispartof>Pediatric surgery international, 2015-06, Vol.31 (6), p.581-587</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-1de02b582d50e3dfffdb19367db56015e8914cf952823ce49d9956df47a8ffac3</citedby><cites>FETCH-LOGICAL-c442t-1de02b582d50e3dfffdb19367db56015e8914cf952823ce49d9956df47a8ffac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25896294$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sato, Hideaki</creatorcontrib><creatorcontrib>Furuta, Shigeyuki</creatorcontrib><creatorcontrib>Tsuji, Shiho</creatorcontrib><creatorcontrib>Kawase, Hirokazu</creatorcontrib><creatorcontrib>Kitagawa, Hiroaki</creatorcontrib><title>The current strategy for urachal remnants</title><title>Pediatric surgery international</title><addtitle>Pediatr Surg Int</addtitle><addtitle>Pediatr Surg Int</addtitle><description>Background
Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR.
Materials and methods
A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome.
Results
We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59 %), a urachal cyst in 5 (18 %) and a urachal duct in 6 (22 %). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (
n
= 6, 54 %). Group B was dominated by abdominal pain (
n
= 12, 75 %). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA,
n
= 7) rather than the classical umbilical approach (UA,
n
= 13). The operation time was not significantly different (LA = 124 min: UA = 110 min,
P
> 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA.
Conclusion
Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Laparoscopy</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Postoperative Complications - surgery</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Urachal Cyst - surgery</subject><subject>Urachus - surgery</subject><issn>0179-0358</issn><issn>1437-9813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kMtKxDAUhoMozjj6AG6k4EYX0ZykSZOlDN5gwM24Dmkuc6HTjkm78O1t6SgiuDqL853__HwIXQK5A0KK-0QIkwwT4JgVQDEcoSnkrMBKAjtGUwKFwoRxOUFnKW0JIZIJdYomlEslqMqn6Ha59pntYvR1m6U2mtavPrPQxKyLxq5NlUW_q03dpnN0EkyV_MVhztD70-Ny_oIXb8-v84cFtnlOWwzOE1pySR0nnrkQgitBMVG4kou-qZcKchsUp5Iy63PllOLChbwwMgRj2QzdjLn72Hx0PrV6t0nWV5WpfdMlDUICFZQW0KPXf9Bt08W6bzdQRHAlhOopGCkbm5SiD3ofNzsTPzUQPXjUo0fdt9ODRz0kXx2Su3Ln3c_Ft7geoCOQ-lW98vHX639TvwBrEHu-</recordid><startdate>20150601</startdate><enddate>20150601</enddate><creator>Sato, Hideaki</creator><creator>Furuta, Shigeyuki</creator><creator>Tsuji, Shiho</creator><creator>Kawase, Hirokazu</creator><creator>Kitagawa, Hiroaki</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20150601</creationdate><title>The current strategy for urachal remnants</title><author>Sato, Hideaki ; Furuta, Shigeyuki ; Tsuji, Shiho ; Kawase, Hirokazu ; Kitagawa, Hiroaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-1de02b582d50e3dfffdb19367db56015e8914cf952823ce49d9956df47a8ffac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Laparoscopy</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Postoperative Complications - surgery</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Urachal Cyst - surgery</topic><topic>Urachus - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sato, Hideaki</creatorcontrib><creatorcontrib>Furuta, Shigeyuki</creatorcontrib><creatorcontrib>Tsuji, Shiho</creatorcontrib><creatorcontrib>Kawase, Hirokazu</creatorcontrib><creatorcontrib>Kitagawa, Hiroaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric surgery international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sato, Hideaki</au><au>Furuta, Shigeyuki</au><au>Tsuji, Shiho</au><au>Kawase, Hirokazu</au><au>Kitagawa, Hiroaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The current strategy for urachal remnants</atitle><jtitle>Pediatric surgery international</jtitle><stitle>Pediatr Surg Int</stitle><addtitle>Pediatr Surg Int</addtitle><date>2015-06-01</date><risdate>2015</risdate><volume>31</volume><issue>6</issue><spage>581</spage><epage>587</epage><pages>581-587</pages><issn>0179-0358</issn><eissn>1437-9813</eissn><abstract>Background
Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR.
Materials and methods
A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome.
Results
We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59 %), a urachal cyst in 5 (18 %) and a urachal duct in 6 (22 %). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (
n
= 6, 54 %). Group B was dominated by abdominal pain (
n
= 12, 75 %). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA,
n
= 7) rather than the classical umbilical approach (UA,
n
= 13). The operation time was not significantly different (LA = 124 min: UA = 110 min,
P
> 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA.
Conclusion
Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25896294</pmid><doi>10.1007/s00383-015-3712-1</doi><tpages>7</tpages></addata></record> |
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| ispartof | Pediatric surgery international, 2015-06, Vol.31 (6), p.581-587 |
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| source | Springer Nature |
| subjects | Adolescent Child Child, Preschool Female Humans Infant Infant, Newborn Laparoscopy Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Original Article Pediatric Surgery Pediatrics Postoperative Complications - surgery Retrospective Studies Surgery Treatment Outcome Urachal Cyst - surgery Urachus - surgery |
| title | The current strategy for urachal remnants |
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