Early laparoscopy for ileocolic intussusception with multiple recurrences in children
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Published on: March 24, 2023
Yu-Tang Chang1, Jui-Ying Lee, Jaw-Yuan Wang
1Department of Surgery, Faculty of Medical School, Division of Pediatric Surgery, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan.
Insights
Early laparoscopy in children with recurrent ileocolic intussusception effectively prevents further episodes and identifies lead points. This minimally invasive approach is safe and avoids later complications, offering a viable treatment strategy.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Recurrent ileocolic intussusception poses risks of subsequent episodes and undetected lead points.
- Early intervention is crucial to mitigate these risks in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of early laparoscopic intervention for ileocolic intussusception with multiple recurrences.
- To assess the ability of laparoscopy to detect lead points and prevent recurrence.
Main Methods:
- Six children with recurrent ileocolic intussusception underwent laparoscopic appendectomy and ileocolonic "pixie" with nonabsorbable sutures.
- Procedures were performed after successful hydrostatic reduction using a 5-mm laparoscope and stab incisions.
Main Results:
- The mean operative time was 68.8 minutes, with no operative morbidity observed.
- No lead points were identified in any patient during the study.
- Follow-up averaged 10.8 months, with no instances of recurrence.
Conclusions:
- Early laparoscopic intervention is recommended for pediatric ileocolic intussusception with multiple recurrences after successful non-surgical reduction.
- Laparoscopy is an acceptable approach for identifying etiologic lesions and preventing future complications.
- This strategy effectively avoids repeat recurrences and associated surgical morbidity.
Background:
The risks of subsequent episodes and a lead point are common problems in ileocolic intussusception with more than two recurrences. To decrease subsequent recurrence and to detect a lead point, an early laparoscopy was performed for children with ileocolic intussusception.
Methods:
This study enrolled six children with multiple recurrences of ileocolic intussusception from January 2004 to August 2007. Using a 5-mm laparoscope and two additional transabdominal wall stab incisions, an appendectomy and an ileocolonic pixie with nonabsorbable sutures were performed simultaneously for all the children after the last successful hydrostatic reduction.
Results:
The mean operating time was 68.8 +/- 12.6 min (range, 55-86 min). There was no operative morbidity, and no lead point was found in any child. The mean follow-up period was 10.8 +/- 6.7 months (range, 2-20 months). No recurrence was observed during this period.
Conclusion:
The authors suggest that early intervention should be undertaken for ileocolic intussusception with multiple recurrences in children after the last nonsurgical reduction has been attempted successfully. Under this strategy, laparoscopy is an acceptable approach. It allows differentiation of a specific etiologic lesion, the possibility of incomplete reduction, and additional proximal invaginations. Later complications, such as repeat recurrence and associated surgical morbidity, also can be avoided.
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