Bladder Diverticulectomy



Fig. 14.1
Port placement for bladder diverticulectomy using three ports



The ureters, and vas deferens in males, are identified and the bladder is mobilized to expose the diverticulum. A hitch stitch can be used to retract the bladder. Alternatively, an additional working port may be placed in the suprapubic midline to aid with retraction. The diverticulum is mobilized circumferentially and the neck of the diverticulum is exposed. Great care is taken to avoid injury to the rectum and adjacent vagina in females. The balloon within the diverticulum is deflated and removed. The neck of the diverticulum is then ligated or transected and closed with an absorbable suture. Gentle irrigation through the urethral catheter may be used to test the integrity of the repair. The resected diverticulum is then removed through a working port or through a port site incision, which may be enlarged if necessary. A drain may be placed adjacent to the diverticulum per surgeon preference. The ports are then removed, and the port sites closed, in the usual fashion.



Postoperative Management/Complications


The Foley catheter remains in place for several days. A voiding cystourethrogram may be performed prior to removal of the catheter. If a drain is left in place, it may be removed 24–48 h after removal of the Foley catheter. If there is concern for a urine leak, a fluid creatinine level may be obtained.


Results


Bladder diverticulectomy is an uncommon procedure in the pediatric population. In the adult literature, laparoscopic diverticulectomy is associated with a shorter hospital stay, less blood loss, less postoperative pain, and longer operative times [5]. Small case series have been reported in the literature with uniformly low complication rates and excellent outcomes.


Author Remarks


Laparoscopic diverticulectomy may be performed extraperitoneally [6] or pneumovesicoscopically [7]. These approaches preserve the integrity of the peritoneum, eliminating manipulation of the bowel. In addition, if a urine leak develops, it is contained within the extraperitoneal space.

Robotic-assisted laparoscopic diverticulectomy has also been described in both pediatric [8] and adult populations [9]. At this point, it is unclear if the benefits of improved articulation and three-dimensional viewing outweigh the additional procedural costs of this technology.

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Dec 28, 2016 | Posted by in PEDIATRICS | Comments Off on Bladder Diverticulectomy

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