Meckel's Diverticulectomy

Meckel’s diverticulum is a birth defect in which a small pouch (diverticulum) is seen in the small intestine of a child during the developmental period inside the mother’s womb. An MD forms near the point where the small and large intestine meet. The pouch does not contain tissues from the small intestine; instead, it is made of tissues from the pancreas or stomach. Most individuals do not develop any symptom from the condition, therefore, it goes unnoticed. However, in some individuals, the pouch produces acids that irritate the wall of the small intestine. Over time, Meckel's diverticulum results in ulcers that can worsen and bleed. In addition, MD can result in the following conditions:

• Peritonitis: Peritonitis is a serious infection resulting from the leakage of fluids from the pouch inside the small intestine and stomach.
• Volvulus: A condition that causes the pouch to twist and cut off the blood supply to the small intestine.
• Intussusception: Another condition that causes the pouch to fold inwards.

Meckel’s diverticulectomy is performed to help prevent troublesome symptoms of MD. It involves removal of the pouch and ulcerated or damaged part of the intestine, and straightening out the twisted part of the intestine if required.

This surgery is recommended to provide relief from the symptoms of MD and repair the intestine. Symptoms of MD vary depending on the age of the affected individual and are as follows:

• Bleeding from the rectum
• Blood in stool
• Vomiting
• Stomach pain
• Constipation
• Fever
• Swelling in stomach
• Inability to pass gas

MD is rarely identified in adults, but surgery is recommended if bleeding or other complications develop.

A surgeon will not perform this procedure in individuals with omphalocele (birth defect of the abdominal wall).

This surgery may not be recommended if Meckel’s diverticulum has been found out accidentally and does not have symptoms. However, the decision to perform the operation is based on the following risk factors:

• People aged below 50 years
• Length of diverticulum less than 2 cm
• Male sex
• Abnormal characteristics within the diverticulum

The surgeon will ask you or your child to visit the hospital a few days before the surgery for a preoperative assessment wherein the medical team will conduct several tests, including:

• Blood test
• Stool test
• Meckel’s scan (involves injecting a radioactive substance in the veins)
• Ultrasound scan
• X-ray
• Laparoscopy (involves inserting an instrument called a laparoscope, a tube fitted with a camera and a light source, inside the abdomen to view the internal organs).

In addition, the following preparation is required before the surgery:

• Inform your surgeon if you are pregnant
• Share the medical history and a list of medicines that you or your child take, including supplements, herbs, or over-the-counter medications.
• Discontinue blood-thinning medicines such as warfarin, clopidogrel, ibuprofen, aspirin, or vitamin E.
• If you smoke, you will be advised to stop smoking. This will help prevent the risk of complications associated with the surgery.
• The doctor will give a list of medicines that you or your child can take till the day of the surgery.
• Remove all your body piercings, make-up, and nail polish before arriving at the hospital on the scheduled day of the surgery.
• Arrange a friend, family member, or responsible adult to drive you home after the procedure.
• If you develop a cold, flu, or fever on the days leading up to the surgery, you should inform the surgeon.
• Fasting is recommended during the surgery. Your surgeon will give you instructions for fasting required before the surgery. 

Once you or your child is admitted to the hospital, the hospital staff will provide you with a hospital gown. They may also start an intravenous (IV) line in your hand to supply essential fluids and medicines during the surgery. You will be given general anaesthesia (medicine to put into sleep) prior to the procedure. Also, pain-relief medicines, antibiotics, and essential fluids will be given to you before the surgery. Meckel's diverticulectomy is performed by an open or a laparoscopic method.

The steps for performing an open surgery include:

• The surgeon will open your abdomen with a large vertical incision (cut).
• He/she will access the MD through this incision and remove it from your intestinal wall.
• In some cases, MD is removed along with a small section of the intestine and the two healthy ends of the intestine left after removal of the section will be stapled or sewn together.

During laparoscopic surgery:

• The surgeon will make small cuts on your abdomen. If required, he/she will also make another larger cut, up to 7.5 cm long. 
• Through the incisions, the surgeon will insert surgical instruments and a camera into your abdominal cavity. He/she will fill your abdomen with gas to help provide more area to operate.
• The surgeon will remove the Meckel’s diverticulum along with a section of your intestine if necessary, and sew or staple the healthy ends of your intestine together.

The incisions will be closed with dissolvable stitches. Hence, their removal is not required after the surgery. You will be kept under observation at the hospital for one to seven days, depending on the extensiveness of the surgery. During the hospital stay, the following things can be expected:

• The surgeon will place in a nasogastric tube inside your stomach (via your nose) to help empty your stomach contents and relieve nausea and vomiting.
• The hospital staff will encourage you to get out of the bed and walk around. This will reduce the risk of blood clots.
• You will be given essential nutrients and fluids through an IV line, at least for one day after the surgery or until you are comfortable to eat or drink. This will give the operated area some time to heal. Thereafter, you will first be put on a liquid diet and then gradually moved to solid food.
• The surgeon will prescribe various medicines, including painkillers, antibiotics, and anti-nausea medications to help reduce the discomfort and prevent infection post-surgery.

After getting discharged from the hospital, you will need to take care of yourself in the following manner:

• You will have to take pain-relief medications and laxatives (helps to loosen stools) for a while after the surgery. 
• Keep the operated site clean and dry for at least two to three days or until your surgeon suggests you to. Use either mild soapy water or salted water to clean the wound. However, avoid using alcohol, iodine, peroxide and soaps that contain antibacterial chemicals. Using them may slow down the healing and damage the wound tissue.
• Avoid using herbal remedies, lotions, or creams around the wound without consulting the surgeon.
• While taking a bath, avoid soaking the operated area till it is healed.
• Avoid lifting heavy objects or indulging in strenuous activities for a few weeks after the surgery based on the type of surgery as below. 
  • Open surgery: Four to six weeks
  • Laparoscopic surgery: One to two weeks
• You will be able to resume a regular diet after discharge from the hospital.

When to see the doctor?

You should contact the surgeon at the earliest if you experience any of the following:

• Body temperature over 100.5^°F (38^°C)
• Redness and swelling at the operated area
• Pain or bleeding from the incision site
• The incision looks dark or dried out
• Foul-smelling discharge from the wound

The following complications are associated with the surgery:

• Damage to adjacent abdominal organs
• Tissues bulging through the incision
• Wound infection
• Intestinal blockage 
• Opening of the stitches in the intestine
• Scarring at the operated site
• Bleeding
• Formation of blood clots
• Breathing problems
• Allergic reaction to anaesthesia

Your follow-up appointment will be scheduled one to three weeks following the surgery to ensure that you are healing well.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.