- Exploration and identification
- Locate Meckel’s diverticulum: typically ~60 cm from ileocaecal valve on anti-mesenteric border of ileum
- Inspect base, wall, and adjacent ileum
- Look for signs of inflammation, ulceration, bleeding, or ectopic tissue
- Technique selection
- If narrow-based and non-inflamed:
- Wedge excision of diverticulum may be performed using a linear stapler or sharp dissection
- Ensure inclusion of all ectopic mucosa
- If broad-based, inflamed, bleeding, or near mesentery:
- Perform a segmental small bowel resection with primary anastomosis
- Preferred if involvement of adjacent ileum or suspicion of malignancy
- Diverticulectomy alone
- Apply atraumatic bowel clamps or use stapler
- Excise diverticulum flush with ileal wall
- Close enterotomy with absorbable sutures in two layers or staple transversely across base
- Ensure haemostasis and no air leak
- Segmental resection (if needed)
- Isolate bowel segment
- Divide mesentery carefully, preserving arcades
- Resect affected ileal segment
- Perform end-to-end anastomosis (hand-sewn or stapled)
- Check for integrity, bleeding, and mesenteric perfusion