M. Grunvald1, N. J. Skertich1, M. Ingram2, E. Ritz3, S. Pillai1, M. Madonna1, A. N. Shah1, M. V. Raval2 1Rush University Medical Center,Division Of Pediatric Surgery, Department Of Surgery,Chicago, IL, USA 2Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago,Division Of Pediatric Surgery, Department Of Surgery,Chicago, ILLINOIS, USA 3Rush University Medical Center,Rush Bioinformatics And Biostatistics Core,Chicago, IL, USA
Introduction:
Meckel’s Diverticulum (MD) is a common congenital anomaly of the gastrointestinal tract caused by a persistent vitelline duct. It accounts for half of pediatric gastrointestinal hemorrhages and can cause obstruction, intussusception, and infection. Although the laparoscopic technique has gained popularity, no large scale studies exist comparing open and laparoscopic approaches and conversion rates remain high. We sought to compare postoperative outcomes associated with each approach and to determine risk factors for conversion to an open procedure.
Methods:
The National Surgical Quality Improvement Program-Pediatric was used to identify patients who underwent surgical repair of a Meckel’s diverticulum from 2012-2018. Outcomes between patients who were treated with a laparoscopic versus open surgery were compared. Chi-square tests and adjusted logistic regression analysis were used to determine significant differences in patient outcomes between treatment groups and factors associated with conversion.
Results:
Among the 681 patients identified, there were 295 (43.3%) open, 386 (56.7%) laparoscopic, and 119 (30.8%) laparoscopic converted to open patients. Patients undergoing laparoscopic compared to open procedures had shorter length of stay (LOS) (3 vs. 4 days, p<0.001), fewer unplanned intubations (0.0 vs. 2.4%, p=0.003), less bleeding requiring transfusion (3.4 vs. 6.8%, p=0.04) and lower mortality (0.0 vs. 1.7%, p=0.015) without significantly different overall complication rates (11.9 vs. 14.9%, p=0.25) or longer mean operative times (77.3 vs. 76.6 minutes, p=0.84). On adjusted logistic regression analysis, only a higher American Society of Anesthesiologists Classification (ASA Class) was predictive of higher overall morbidity rate, not operative technique. Patients requiring conversion to open did not have significantly different morbidity rates (14.3 vs. 10.9, p=0.34), but did have longer operative times (90.1 vs 71.6 minutes, p<0.001) and length of hospital stay (4 vs. 3, p=0.001). They were also more likely to have a history of cardiac risk factors on adjusted logistic regression analysis (Odds ratio 5.5. 95% Confidence Interval 1.1, 27.5, p=0.038).
Conclusion:
Laparoscopic MD repair has fewer complications, lower mortality, shorter LOS, with no significant increase in operative time compared to an open approach. Despite a high laparoscopic to open conversion rate, overall morbidity remained low and not significantly different, although LOS and operative time increased.
