Comments on the Meckelostomy procedure

VD Yagnik 
 Consultant Endoscopic and Laparoscopic Surgeon, Ronak Endo-Laparoscopy and General Surgical Hospital, Patan,Gujarat, India

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V D Yagnik
Consultant Endoscopic and Laparoscopic Surgeon, Ronak Endo-Laparoscopy and General Surgical Hospital, Patan,Gujarat
India

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Sir,

I read an article entitled "What Johann Friedrich Meckel did not think of when he named the diverticulum!" [1] with interest. It is really an interesting case and the approach the authors had adopted is really a good example of prompt and wise intraoperative decision. I do agree with the authors that Meckel's is easy to find, short, with a broad base and can be handled conveniently even by a surgeon who lacks outstanding experience and also agree about the addition of the term Meckelostomy in the literature. As this patient was terminally ill and the life expectancy was short, it was the most suitable option. It is really a fascinating approach to go for Meckelostomy. Cennamo et al. [2] recommend that incidentally found diverticulum should always be removed because the morbidity of secondary complications is more severe compared with any discomfort following its surgical removal. Optimal management of incidentally found Meckel's is controversial. [3] I would like to know from the authors whether they recommend confirming the presence of heterotopic mucosa before Meckelostomy? As these patients are more likely to develop complications associated with Meckel's diverticulum, the life time complication rate for Meckel's is around 4%. [4] I would not recommend its routine use whenever it is found in patients posted for either ileostomy or colostomy, as complications of Meckel's is an additional morbidity and can be avoided by spending 10-15 min more to perform ileostomy or colostomy.

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