Can a stapler be used for surgical resection of Meckel's diverticulum in patients, including pediatric and adult populations?

Surgical Stapler Use for Meckel's Diverticulum

Yes, surgical staplers can be safely and effectively used for resection of Meckel's diverticulum, with both tangential stapler excision and wedge resection being appropriate techniques depending on the diverticulum's characteristics.

Stapler Technique Selection

The choice between stapler techniques depends on specific anatomical features of the diverticulum:

For Long Diverticula (Height-to-Diameter Ratio >2)

• Tangential stapler excision (diverticulectomy) is the preferred method when the diverticulum base and adjacent ileum are intact 1, 2
• Long diverticula have ectopic tissue located at the body and tip rather than the base, making simple tangential excision safe 1
• This technique has been successfully performed laparoscopically with no staple-line leaks reported in case series 2

For Short Diverticula (Height-to-Diameter Ratio ≤2)

• Wedge resection using staplers is recommended because short diverticula have wide distribution of ectopic tissue including the base 1
• Wedge resection includes a portion of the adjacent ileal wall to ensure complete removal of heterotopic tissue 1

Clinical Scenarios Requiring Specific Stapler Approaches

Simple Diverticulitis

• Diverticulectomy (tangential stapler excision) for long diverticula 1
• Wedge resection for short diverticula 1

Complicated Presentations

• Wedge or segmental resection is mandatory for complicated diverticulitis with perforated base, complicated intestinal obstruction, or tumor 1
• Bleeding Meckel's diverticulum requires wedge or segmental resection as the preferred methods, not simple diverticulectomy 1

Incidentally Discovered Diverticula

• If resection is indicated (patient <50 years, male sex, length >2 cm, or abnormal features), use diverticulectomy for long and wedge resection for short diverticula 1, 3
• Patients under 50 years have 70% risk of becoming symptomatic compared to only 10% in those over 50 years 3

Technical Outcomes with Stapler Use

• No staple-line leaks were reported in a 12-year series of laparoscopic stapler resections (10 tangential, 2 wedge excisions) 2
• Hospital discharge occurred between postoperative days 4-7 with excellent long-term outcomes 2
• Morbidity rates are equivalent between stapler resection of incidental versus symptomatic diverticula (no significant difference, p=0.71) 4

Critical Pitfalls to Avoid

• Do not perform simple diverticulectomy for bleeding diverticula—the ectopic gastric mucosa causing bleeding may extend to the base, requiring wider excision 1
• Do not assume the absence of ectopic tissue based on intraoperative palpation or appearance—heterotopic tissue cannot be accurately predicted macroscopically and is found in 33% of symptomatic cases 1, 3
• Do not use tangential excision for short diverticula—the wide distribution of ectopic tissue at the base necessitates wedge resection 1
• Diverticula with diameter ≤2 cm are significantly associated with more complications (p=0.01) and require careful surgical planning 4

Age-Related Considerations

• Patients under 50 years presenting with Meckel's diverticulum are significantly more likely to be symptomatic (mean age 34.9 years for symptomatic vs 64.2 years for asymptomatic, p=0.0006) 3
• Heterotopic tissue is only identified in symptomatic patients and is more common in younger individuals 3, 4
• The lifetime risk of complications approaches zero after age 70, making prophylactic resection less beneficial in elderly patients 5