Urachus is the embryological remnant of the allantois that connects the fetal bladder to the umbilicus. It usually obliterates in the 5th month of gestation, giving rise to the median umbilical ligament.
Several types of urachal anomalies have been described including urachal cyst, patent urachus, diverticulum, the sinus, of which urachal cysts is the most common anomaly, occuring in approximately 1/5,000 births. Urachal cysts are usually asymptomatic but may present as acute abdomen (secondary to infection), the become palpable.
We performed a light assisted mucosa sparing laparoscopic excision of a urachal cyst in a 24-year-old girl who presented with lower abdominal midline swelling. MR of the abdomen the pelvis revealed an anterior midline urachal cyst located just superior to the bladder that measured 6.2 x 4.5 cm. Management options of the urachal cyst were discussed with the patient the she was planned for laparoscopic excision.
On the table, cystoscopy the cystography were performed initially to identify any possible connection between the bladder the the urachal cyst. The patient was placed in the dorsal lithotomy the Trendelenberg position.
Peritoneal access was obtained using the open Hasson technique with placement of the 12-mm camera port in the midline using a vertical incision halfway between the umbilicus the the xiphoid process .
After creation of pneumoperitoneum, two additional ports (12 mm each) were inserted under direct vision at the anterior axillary lines just above the leve l of the umbilicus (one on each side).
Dissection began with lysis of the omental adhesions. After adhesiolysis, both the obliterated umbilical arteries were cauterized the divided to gain access to the anterior bladder wall. The urachal cyst was dissected from the anterior abdominal wall the mobilized all around, except at its attachment to the bladder, using a harmonic scalpal. The cystoscopy was carried out at this stage to visualize the demarcation between the cyst the the bladder wall with the help of a cystoscopic light. The bladder was kept partially distended to assist dissection between the bladder mucosa the cyst wall. Under cystoscopic light guidance, the cyst was dissected from the bladder wall without opening the bladder mucosa . The bladder was distended via the Foley catheter to ensure that there was no rent in bladder mucosa. The muscle defect was closed by running a 3-0 vicryl suture. The cyst was decompressed after taking it in an endobag the delivered from camera port. The Foley catheter was kept indwelling for 24 hours.
Histopathological examination of the cyst confirmed the presence of a benign urachal cyst with chronic inflammatiory changes.
Urachal cyst is an uncommon urachal anomaly having delayed presentation due to non specific signs the symptoms. Complete excision of the cyst is the treatment of choice.
Laparoscopic excision is increasingly being used with results comparable to open surgery with the advantages of a minimally invasive approach. Light guided mucosa sparing laparoscopic cyst excision is a novel technique which, in addition to being minimally invasive, will also reduce the complications associated with opening of bladder mucosa such as urinary leakage the bleeding, as well as having a shorter catheter time.
Submitted: 15 May, 2016
Accepted: 29 August, 2016
Published: 29 August, 2016
CONFLICTS OF INTEREST:
The authors declare no conflicts of interest.