Glenn Ian C, El-Shafy Ibrahim Abd, Bruns Nicholas E, Muenks E Pete, Duran Yara K, Hill Joshua A, Peter Shawn D St, Prince Jose M, Lipskar Aaron M, Ponsky Todd A
Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
Pediatr Surg Int. 2018 Apr;34(4):451-455. doi: 10.1007/s00383-018-4239-z. Epub 2018 Feb 19.
It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD.
A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection. Exclusion criteria were comorbid surgical conditions and other causes of GIB. The primary outcome was post-operative bleeding during the initial hospitalization. Secondary outcomes were bleeding after discharge, transfusion or additional procedure requirement, re-admission, and overall complications.
There were 59 patients who met study criteria (42 diverticulectomy, 17 SBR). One patient in the SBR group had early post-operative bleeding (p = 0.288). There was one re-admission (p = 0.288) and three total complications in the SBR group (p = 0.021). There were no cases of bleeding or other complications in the diverticulectomy group.
This study suggests that simple diverticulectomy is adequate for treatment of GIB caused by MD. Furthermore, diverticulectomy appears to have a lower overall complication rate.
对于梅克尔憩室（MD）继发的胃肠道出血（GIB），单纯憩室切除术而非节段性肠切除术（SBR）是否为充分的治疗方法尚不清楚。有人担心，如果仅切除憩室，相邻肠段的溃疡可能会继续出血。本研究旨在确定憩室切除术对于出血性MD是否为令人满意的治疗方法。
对诊断为MD和GIB并接受单纯憩室切除术或小肠切除术的患者进行了多机构回顾性研究。排除标准为合并手术情况和GIB的其他病因。主要结局为初次住院期间的术后出血。次要结局为出院后出血、输血或需要额外手术、再次入院及总体并发症。
有59例患者符合研究标准（42例行憩室切除术，17例行SBR）。SBR组有1例患者术后早期出血（p = 0.288）。SBR组有1例再次入院（p = 0.288）和3例总体并发症（p = 0.021）。憩室切除术组无出血或其他并发症病例。
本研究表明，单纯憩室切除术足以治疗由MD引起的GIB。此外，憩室切除术的总体并发症发生率似乎较低。
