The urachus is a tube that connects the bladder to the umbilicus during fetal development. After birth, the urachus normally closes and becomes a ligament.
Surgery is recommended for a patent urachus that does not close after birth. There is some variablity in the degree of the defect. Sometimes, only the umbilical end of the urachus fails to close, generating a urachal sinus, which does not connect with the bladder, but simply eneters the skin for a short distance. These can usually be excised locally. If the entire urachus is patent all the way to the bladder, the urachus must be excised and the bladder closed.
While the infant is deep asleep and pain-free (using general anesthesia), an incision is made in the lower abdomen, below the umbilicus.
The urachus is located and removed from the umbilicus and the bladder. The bladder opening is repaired, and the incision is closed.
The outcome is usually excellent. The infant can be fed normally and should recover rapidly. A few days of hospitalization is all that is usually required.