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Laparoscopic excision of infected urachal cyst: Illustrationof techniqueash_493 77

Dennis Chung-Kei Ng, Kevin Kwok-Kay Yau* and Michael Ka-Wah LiDepartment of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China

The urachus is a fibrous cord structure connecting the

urinary bladder dome and the umbilicus.1 Persistent

urachal anomalies are rare conditions which com-

monly present as infection. Conventional treatment

is excision of the umbilicus together with the entire

tract with or without a cuff of the urinary bladder.23

Complete excision will result in a large laparotomy

wound and related short-term disadvantage. With

the advance of the laparoscopic technique, more

and more patients have undergone laparoscopic

excisions.46 We herein report a case and illustrate the

laparoscopic technique in the accompanying video.

A 22-year-old man presented to us with a 3-day

history of umbilical pain and fever and was not

responding to antibiotic treatment prescribed by a

private doctor. On physical examination, his umbilicus

was inflamed with some pus-like discharge. Contrast

computed tomography (CT) scan was carried out and

findings were suggestive of infected urachus. Laparo-scopic excision of the infected urachus was sug-

gested to the patient and he agreed to the operation.

The operation was carried out under general ana-

esthesia and the patient was placed in the supine

position. A urinary catheter was inserted. One

1011-mm camera port was inserted in the right side

of the patients abdomen at the level of the umbilicus

by an open technique. Two 5-mm working ports were

then inserted under laparoscopic guidance. All ports

were placed at the right side of the abdomen. Thirty-

degree laparoscopy was used so that it gave a clear

view of the posterior surface of the anterior abdominalwall. An ultrasonic dissector was used to dissect the

peritoneum around the infected urachal cyst. Further

dissection was carried out along the preperitoneal

plane so that the entire median umbilical ligament was

dissected out. We traced down along the tract until the

dome of the urinary bladder was reached. The urinary

bladder was then distended with 300-mL methylene

blue solution. Double clipping of the tract was applied

just proximal to the dome of the urinary bladder. The

whole tract was fully mobilized up to the umbilical

attachment. Trans-umbilical elliptical skin incision was

carried out and the tract separated from the umbilicus.

The entire tract was then retrieved through the umbili-

cal wound with a specimen bag. The umbilical fascia

was closed with interrupted PDS-1 sutures and the

umbilicus was reconstructed with interrupted 3-0

nylon. Other port sites and skin wounds were closed

with subcuticular sutures. The patient recovered well

and was discharged the next day after operation.

Video image

Additional video images may be found in the online

version of this article.

Visit http://cshk.org/surgical_practice/multi-media_article/May_2010_issue_MM4_video.htmPlease note: Wiley-Blackwell are not responsible for the content

or functionality of any supporting materials supplied by the

authors. Any queries (other than missing material) should be

directed to the corresponding author of the article.

References

1. Gearhart JP. Exstrophy, epispadias, and other bladder

anomalies. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ

(eds). Campbells Urology, 8th edn. Philadelphia, PA: Saun-

ders, 2002; 213696.

2. Blichert-Toft M, Nielson OV. Diseases of the urachus simulat-ing intra-abdominal disorders.Am. J. Surg.1971;122: 1278.

3. Berman SM, Tolia BM, Laor E et al. Urachal remnants in

adults. Urology1988; 31: 1721.

4. Chiarenza SF, Scarpa MG, DAgostino S et al. Laparoscopic

excision of urachal cyst in pediatric age: report of three cases

and review of the literature. J. Laparoendosc. Adv. Surg.

Tech. A 2009; 19 (Suppl 1): S1836.

5. Castillo OA, Vitagliano G, Olivares R et al. Complete excision

of urachal cyst by laparoscopic means: a new approach to an

uncommon disorder. Arch. Esp. Urol. 2007; 60: 60711.

6. Siegel JF, Winfield HN, Valderrama E et al. Laparoscopic

excision of urachal cyst.J. Urol. 1994; 151: 16313.*Author to whom all correspondence should be addressed.

Email: yaukk1@ha.org.hk

Received 14 January 2010; accepted 15 January 2010.

Surgical Practicedoi:10.1111/j.1744-1633.2010.00493.x Multi-Media Article

Surgical Practice(2010) 14, 77 2010 The Authors

Journal compilation 2010 College of Surgeons of Hong Kong