This video demonstrate Laparoscopic meckel's diverticulectomy performed by Dr R K Mishra at World Laparoscopy Hospital. Meckel's diverticulum was first described about 400 years ago and continues to be a rare congenital disorder of small intestine. Laparoscopic surgery for Meckel's diverticulum has been described as a safe and effective procedure. We present our this video of patient with symptomatic Meckel's diverticulum. The incidence of Meckel's diverticulum at our institution is 0.3%. The majority of patients were male children. There were no staple-line leaks in any case. Laparoscopy is useful in both diagnosis and treatment. Laparoscopic resection of Meckel's diverticulum is feasible and ideal, especially when performed in specialized centers.

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete obliteration of the vitelline (omphalomesenteric) duct. Although often asymptomatic, it can present with complications such as gastrointestinal bleeding, obstruction, inflammation, or perforation. Symptomatic Meckel’s diverticula require surgical intervention, and with advancements in minimally invasive surgery, laparoscopic Meckel’s diverticulectomy has become a safe and effective treatment option.

Clinical Presentation

Patients with symptomatic Meckel’s diverticula may present with:

• Gastrointestinal bleeding: Often painless, usually due to ectopic gastric mucosa causing ulceration.

• Intestinal obstruction: Secondary to volvulus, intussusception, or adhesions.

• Diverticulitis: Mimicking appendicitis.

• Perforation: Rare, but life-threatening.

Preoperative diagnosis can be challenging. Imaging studies such as technetium-99m pertechnetate scan (Meckel scan), CT scan, or MRI may aid in diagnosis.

Indications for Surgery
Surgical intervention is indicated in:

• Symptomatic Meckel’s diverticula.

• Complications like bleeding, obstruction, or perforation.

• Incidentally discovered diverticula in select cases (e.g., long, broad-based, or containing ectopic tissue).

Laparoscopic Approach
Laparoscopic surgery offers several advantages over open surgery, including reduced postoperative pain, shorter hospital stay, faster recovery, and improved cosmesis.

Preoperative Preparation

• Standard preoperative evaluation, including blood tests and imaging.

• Bowel preparation may be considered depending on surgeon preference.

• Prophylactic antibiotics administered according to institutional protocol.

Surgical Technique – Step by Step

1. Patient Positioning and Port Placement

   • Supine position, under general anesthesia.

   • Typically, a three-port technique is used: one umbilical port for the camera and two working ports in the lower abdomen.

2. Exploration and Identification

   • The small bowel is examined from the ligament of Treitz to the ileocecal valve.

   • The Meckel’s diverticulum is identified, often located 60–100 cm proximal to the ileocecal valve.

3. Mobilization

   • The diverticulum is mobilized using atraumatic graspers.

   • Adhesions, if present, are carefully dissected.

4. Diverticulectomy or Segmental Resection

   • Diverticulectomy: Stapler or intracorporeal suturing is used to excise the diverticulum at its base.

   • Segmental small bowel resection: Considered if the base is broad, inflamed, or if there is suspicion of ectopic tissue extending into the ileum.

5. Hemostasis and Inspection

   • Ensure hemostasis and check for bowel integrity.

   • The specimen is retrieved through a port using a bag to avoid contamination.

6. Closure

   • Ports are removed under vision.

   • Fascial closure of ≥10 mm ports, followed by skin closure.

Postoperative Care

• Early ambulation and gradual oral intake.

• Pain management with multimodal analgesia.

• Monitor for complications such as bleeding, infection, or ileus.

• Discharge is typically within 2–4 days for uncomplicated cases.

Outcomes and Advantages

• Laparoscopic Meckel’s diverticulectomy is associated with lower postoperative pain, faster recovery, and excellent cosmetic results compared to open surgery.

• Complication rates are low, with rare instances of anastomotic leak or bowel obstruction.

• Laparoscopy also allows for exploration of the entire small bowel and identification of additional pathology.

Conclusion
Laparoscopic Meckel’s diverticulectomy is a safe and effective technique for managing symptomatic Meckel’s diverticula. It combines the benefits of minimally invasive surgery with effective resolution of symptoms and low complication rates. With increasing experience and surgical expertise, laparoscopy is becoming the preferred approach for both elective and emergency cases of Meckel’s diverticulum.