The Laparoscopic Tangential Resection of Meckel Diverticulum is Safe and Effective to Remove Ectopic Mucosa

Aim: The laparoscopic wedge resection of Meckel Diverticulum (MD) has been reported as safe and effective. However, some authors speculate that a resection of the bowel segment is a safer therapeutic alternative, as a simple diverticulectomy could leave ectopic tissue in situ. The aim of this study was to evaluate whether the tangential resection of MD could be enough to completely remove any MD mucosal abnormalities. Materials and Methods: We reviewed the clinical charts of 40 patients who underwent surgery for MD during the period 2005–2016 in our unit. We described and analyzed the following parameters: patients’ general characteristic (age, F/M ratio, BMI), rate of complicated and incidental MD, percentage of tangential resections, rate of laparoscopic surgery, conversion rate, complication rate, mean length / width of MDs, and histological findings. Results: In eleven years, 40 patients presented an MD. Mean age was 57.7 yrs (range 2–86), F/M ratio 1:3 and mean BMI 27,72 kg/m2 (range 18,7–49). 62% MD (25/40) were incidentally identified during surgical operations done for other causes, the remaining 38% (15/40) were symptomatic. Stapled tangential resection was performed in 38/40 (95%) patients; in the remaining 5%, a segmental resection with primary side-to-side anastomosis was carried out. 21/38 (55%) were approached laparoscopically and 38% of those were converted. No postoperative complications related to the stapled resection of the diverticulum were identified. The mean diverticular length was 4.1 cm (range 2–9 cm) and the mean base diameter was 2.4 cm (range 1.2-4 cm). The mean height-to-diameter ratio (HDR) was\2. MD presented a normal mucosa in 16/40 patients (40%), flogosis and/or necrosis in 18/40 (45%), a gastric mucosa in 4/40 (10%), a pancreatic-type mucosa in 1/40 (3%) and a well differentiated neuroendocrine tumor in 3% (1/40). In all MDs with ectopic mucosa, the edge along the margin of resection was free of cellular metaplasia/dysplasia. Conclusion: The diverticulectomy performed by “firing” a stapler at the base of the Meckel diverticulum is safe and effective to completely remove any eventual mucosal abnormalities.