The truth behind the "rule of twos" the Meckel diverticulum revised

Summary BACKGROUND: The diagnosis and treatment of the Meckel diverticulum (MD) continue to fascinate abdominal surgeons. The "disease of the twos" must be reconsidered in the context of emerging laparoscopic techniques. METHODS: A meta-analysis of recent large studies reporting MD especially in adults was undertaken. RESULTS: The morbidity and mortality of 1116 incidental resections were 3.67 and 0.18%, respectively, while after surgery for 502 symptomatic diverticula, a morbidity of 9.56% and a mortality of 1.99% were found. The difference is highly significant. From recent data in the literature we have generated an algorithm for the approach towards the incidentally detected MD. CONCLUSIONS: Although the management of asymptomatic diverticula is still controversial, new data show that incidental diverticulectomy can be performed with morbidity and mortality rates far below the rates for symptomatic cases. This led us to recommend removal of the asymptomatic MD when surgically justifiable.