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Minimally invasive approach in the management of childhood intussusception
Sing T Cheung1, Kim H Lee, Tse H Yeung
1Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. gloriacst@yahoo.com.bk
Insights
Minimally invasive techniques like pneumatic and laparoscopic reduction are effective for childhood intussusception. This approach offers a high success rate with reduced complications and shorter hospital stays compared to traditional surgery.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Intussusception is a common cause of intestinal obstruction in infants.
- Non-operative hydrostatic reduction is the standard treatment, but surgery is sometimes necessary.
- Minimally invasive techniques are increasingly applied to intussusception reduction in children.
Purpose of the Study:
- To review the experience with a combined pneumatic and laparoscopic reduction approach for childhood intussusception.
- To evaluate the success rate and complication incidence of this minimally invasive strategy.
Main Methods:
- Retrospective analysis of 146 children with 167 intussusception episodes (December 1998 - December 2004).
- Prioritization of minimally invasive reduction techniques, including pneumatic and laparoscopic methods.
- Analysis of reduction success, complications, and hospital stay duration.
Main Results:
- Pneumatic reduction was successful in 83.8% of 160 episodes.
- Laparoscopic reduction was successful in 13 of 15 attempted cases (86.7%) when pneumatic reduction failed.
- Minimally invasive approaches resulted in significantly shorter hospital stays (median 3 days) versus laparotomy (median 8 days) with no procedure-related complications.
Conclusions:
- A combined pneumatic and/or laparoscopic reduction approach is highly successful for childhood intussusception.
- This minimally invasive strategy offers reduced morbidity and shorter hospital stays.
- Minimally invasive techniques represent an effective alternative for intussusception management in children.
Background:
Intussusception is one of the most common causes of intestinal obstruction in infancy. Non-operative reduction using air enema or other hydrostatic reduction methods has been the standard treatment in most cases. However, if the non-operative method is not indicated or fails, open surgery is still necessary. With the tremendous development of the minimally invasive approach in handling surgical conditions in children in the last decade, this has been applied recently for the reduction of intussusception in children. We herein reviewed our experience of using the combined approach, namely, pneumatic reduction and, if failed, laparoscopic reduction in the management of childhood intussusception.
Methods:
We carried out a retrospective analysis of all children with intussusception managed at Prince of Wales Hospital between December 1998 and December 2004. The minimally invasive approach was used as far as possible. The method of reduction, success rate and the incidence of complication were analysed.
Results:
Over a 6-year period, there were 146 patients with 167 episodes of intussusception. Pneumatic reduction was carried out in 160 occasions and was successful in 134 (83.8%). In 33 patients, operative reduction was required. Of these, laparoscopic reduction was attempted in 15 and was successful in 13 (86.7%). In those with either pneumatic or laparoscopic reduction, no procedure-related complication was encountered and they had a significant shorter hospital stay (median 3.0 day) than those requiring laparotomy (median 8.0 day) (t-test, P < 0.0001).
Conclusion:
The minimally invasive approach, that is, pneumatic and/or laparoscopic reduction, was successful in reducing intussusception in 88% of patients with minimal morbidity and shorter hospital stay.
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