Yagnik Vipul D, Garg Pankaj, Dawka Sushil
Department of Surgery, Banas Medical College and Research Institute, Palanpur, GJ, India.
Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, GJ, India.
Clin Exp Gastroenterol. 2024 May 7;17:147-155. doi: 10.2147/CEG.S460053. eCollection 2024.
Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined.
Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed.
Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short- and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection.
The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.
梅克尔憩室（MD）是一种常见的胃肠道先天性异常，在手术中偶然发现时会带来两难困境。尽管有关于有症状MD的历史描述和已知并发症，但对于切除偶然发现的MD（IMD）的决定缺乏明确的指导方针。本研究旨在通过综合2000年至2023年发表的研究证据，评估切除IMD是否合理。系统地研究了影响这一决定的因素，如人口统计学风险、手术进展和并发症。
遵循PRISMA 2020指南，本综述纳入了42项符合条件的研究，这些研究提供了无症状MD管理结果的数据。对支持和反对切除的研究进行了分析。
考虑到并发症、恶性潜能和手术安全性，风险效益分析呈现出一个细微差别。一些作者建议根据特定标准进行有条件切除，强调患者特异性因素。在分析的2934例短期和长期并发症病例中，发病率为5.69%。在可获得死亡率数据的571例病例中，所有5例死亡均归因于原发性疾病而非IMD切除。
IMD的散发性、不可预测的表现以及原发性疾病和患者的变异性使得制定明确的指导方针具有挑战性。并发症报告的不一致性凸显了标准化分类的必要性。虽然证据的平衡倾向于切除IMD，但本研究承认这一决定的个体化性质。手术和麻醉安全性的提高，以及对并发症的更好理解和管理，有利于明智地倾向于切除，同时考虑患者特征和原发性疾病。
