BACKGROUND: Incidental Meckel's diverticulectomy has been advocated by some surgeons because of the lower associated morbidity and mortality in this setting than when resection is indicated. Others have argued that the low risk of complication occurrence does not justify prophylactic removal. The issue remains controversial. METHODS: Medical records of all adults undergoing Meckel's diverticulectomy at four acute care hospitals during the 5-year period 1989 through 1993 were retrospectively reviewed. Decision analysis was used to determine relative risks for incidental resection compared to indicated resection for a complication. RESULTS: Ninety patients underwent incidental diverticulectomy. Morbidity was 2% and mortality 0%. Four patients underwent resection for a complication of their diverticulum. Morbidity and mortality were each 0%. Combining these results with previously reported results and using decision analysis, the conditional probabilities of producing surgical morbidity or mortality in the adult population at risk by only resecting symptomatic diverticula are 0.2% and 0.04%, respectively. The comparable risks for resecting all incidentally discovered diverticula are 4.6% and 0.2%. CONCLUSIONS: Incidental diverticulectomy in adults should be abandoned.
BACKGROUND: Incidental Meckel's diverticulectomy has been advocated by some surgeons because of the lower associated morbidity and mortality in this setting than when resection is indicated. Others have argued that the low risk of complication occurrence does not justify prophylactic removal. The issue remains controversial. METHODS: Medical records of all adults undergoing Meckel's diverticulectomy at four acute care hospitals during the 5-year period 1989 through 1993 were retrospectively reviewed. Decision analysis was used to determine relative risks for incidental resection compared to indicated resection for a complication. RESULTS: Ninety patients underwent incidental diverticulectomy. Morbidity was 2% and mortality 0%. Four patients underwent resection for a complication of their diverticulum. Morbidity and mortality were each 0%. Combining these results with previously reported results and using decision analysis, the conditional probabilities of producing surgical morbidity or mortality in the adult population at risk by only resecting symptomatic diverticula are 0.2% and 0.04%, respectively. The comparable risks for resecting all incidentally discovered diverticula are 4.6% and 0.2%. CONCLUSIONS: Incidental diverticulectomy in adults should be abandoned.
Authors: Pragatheeshwar Thirunavukarasu; Magesh Sathaiah; Shyam Sukumar; Christopher J Bartels; Herbert Zeh; Kenneth K W Lee; David L Bartlett Journal: Ann Surg Date: 2011-02 Impact factor: 12.969