Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete obliteration of the vitelline duct. It occurs in about 2% of the population and is usually located on the antimesenteric border of the ileum, approximately 60–100 cm from the ileocecal valve. Although often asymptomatic, it can present with complications such as bleeding, obstruction, diverticulitis, or perforation.

Traditionally managed by open surgery, the advent of minimally invasive techniques has made laparoscopic Meckel’s diverticulectomy the preferred approach for symptomatic cases. Laparoscopy provides both diagnostic and therapeutic benefits, especially when the clinical presentation is atypical.

Pathophysiology and Clinical Presentation

A Meckel’s diverticulum is a true diverticulum containing all layers of the intestinal wall. It often harbors ectopic gastric or pancreatic tissue, which can lead to acid secretion and subsequent ulceration of adjacent ileal mucosa.

Clinical manifestations include:

Bleeding: Painless rectal bleeding due to peptic ulceration, more common in children.

Obstruction: From intussusception, volvulus, or entrapment of bowel loops.

Diverticulitis: Mimics acute appendicitis with abdominal pain, fever, and leukocytosis.

Perforation: Rare but potentially life-threatening.

Incidental finding: Detected during laparoscopy for unrelated conditions.

Diagnosis

Preoperative diagnosis is often challenging. Investigations include:

Technetium-99m pertechnetate scan (Meckel’s scan): Detects ectopic gastric mucosa, particularly in children with bleeding.

CT or MRI: May reveal inflamed or complicated diverticulum.

Capsule endoscopy: Useful in obscure gastrointestinal bleeding.

Diagnostic laparoscopy: Frequently the definitive method of diagnosis in acute abdomen.

Role of Laparoscopy

Laparoscopy serves a dual role:

Diagnostic: Direct visualization of Meckel’s diverticulum when imaging is inconclusive.

Therapeutic: Enables diverticulectomy or segmental resection with minimal morbidity.

Compared to laparotomy, laparoscopy offers faster recovery, less postoperative pain, shorter hospital stay, and superior cosmetic results.

Laparoscopic Surgical Techniques

The choice of procedure depends on the diverticulum’s morphology, base, and presence of complications.

Diverticulectomy (Simple Resection)

Indicated for diverticula with a narrow base and no evidence of inflammation at the ileal junction.

The diverticulum is stapled at its base using an endoscopic linear stapler and excised.

Care is taken to avoid narrowing of the ileal lumen.

Wedge Resection

Suitable for diverticula with a broad base but limited inflammation.

A wedge-shaped excision including the diverticulum and adjacent ileal wall is performed with staplers or sutures.

Segmental Ileal Resection with Primary Anastomosis

Required when the diverticulum is inflamed, perforated, gangrenous, or associated with bleeding ulcers extending into adjacent ileum.

A segment of ileum containing the diverticulum is resected, followed by end-to-end or side-to-side stapled anastomosis.

Adhesiolysis and Complication Management

In cases of obstruction, associated adhesions, volvulus, or intussusception are managed laparoscopically before diverticulectomy.

Operative Steps

Patient Positioning: Supine with Trendelenburg tilt.

Port Placement: Typically three ports: a 10 mm umbilical port for the camera and two 5 mm working ports.

Exploration: Entire small bowel is run laparoscopically until the diverticulum is identified.

Resection: Depending on the base and pathology, stapled diverticulectomy or segmental resection is performed.

Specimen Retrieval: Placed in an endobag and removed via the umbilical port.

Hemostasis and Closure: Ensured before port closure.

Postoperative Care

Early ambulation and oral intake are encouraged within 24 hours.

Analgesia: Provided with minimal opioid requirement due to reduced postoperative pain.

Antibiotics: Continued if diverticulitis or perforation was present.

Monitoring: Watch for signs of ileus, anastomotic leak, or bleeding.

Recovery: Most patients can be discharged within 2–4 days.

Outcomes and Prognosis

Laparoscopic Meckel’s diverticulectomy yields excellent results with low complication and recurrence rates. Studies confirm:

Symptom resolution in the vast majority of cases.

Reduced hospital stay compared to open surgery.

Low morbidity with rare complications like anastomotic leak or abscess.

Superior cosmetic outcome, particularly important in young patients.

Fertility and long-term gastrointestinal function are unaffected.

Advantages of Laparoscopic Approach

Minimally invasive with less pain and faster recovery.

Superior visualization of abdominal cavity.

Diagnostic and therapeutic in the same procedure.

Safe in both elective and emergency settings.

Lower adhesion formation compared to open surgery.

Conclusion

Laparoscopic management of symptomatic Meckel’s diverticulum has become the standard of care, offering a safe, effective, and minimally invasive alternative to open surgery. Depending on diverticular morphology and associated complications, laparoscopic diverticulectomy, wedge resection, or segmental ileal resection may be performed. With its diagnostic precision, therapeutic efficacy, and favorable outcomes, laparoscopy ensures excellent results in both elective and emergency presentations of Meckel’s diverticulum.