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Laparoscopic management of intussusception in pediatric patients
Jason D Fraser1, Pablo Aguayo, Brian Ho
1Department of Surgery, The Children's Mercy Hospital, 2401 Gilham Road, Kansas City, MO 64108, USA.
Insights
Laparoscopy is a safe and effective treatment for pediatric intussusception that fails radiographic reduction. This minimally invasive approach can be used even when bowel resection is necessary, offering a viable alternative for complex cases.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in children.
- Radiographic reduction is the initial treatment of choice.
- Laparoscopic management for irreducible intussusception is less documented.
Purpose of the Study:
- To evaluate the safety and effectiveness of laparoscopy for pediatric intussusception that is irreducible by radiography.
- To assess the utility of laparoscopy in more complex cases requiring intervention.
Main Methods:
- Retrospective review of patients with radiographically irreducible intussusception treated laparoscopically between 1998 and 2008.
- Data collected included patient demographics, intussusception type, operative approach, and outcomes.
Main Results:
- 22 patients (average age 2.9 years, 73% male) were identified.
- 91% of patients were managed laparoscopically or with minor extension of the umbilical incision.
- 10 patients (46%) required bowel resection, with 9 identified as having a pathologic lead point.
Conclusions:
- Laparoscopy is a feasible and effective approach for pediatric intussusception.
- The laparoscopic approach is suitable even when bowel resection is indicated.
- Minimally invasive surgery offers a valuable option for complex pediatric intussusception cases.
Introduction:
Minimally invasive approaches are beginning to be employed in the management of pediatric patients with intussusception who fail radiographic reduction. Successful laparoscopic reduction has been demonstrated, but the utility of laparoscopy, for more complex cases, is less well documented. Therefore, we reviewed our experience with laparoscopy in patients with radiographically irreducible intussusception to document the safety and effectiveness of this approach.
Methods:
We conducted a retrospective review of all of the patients who had a radiographically irreducible intussusception treated via the laparoscopic approach at a single institution from 1998 to 2008. Means are expressed +/- standard deviation.
Results:
A total of 22 patients were identified, with an average age of 2.9 +/- 3.0 years. Average length of stay was 2.67 +/- 1.5 days (median, 2). Sixteen (73%) of the 22 patients were male. There were 19 ileocecal and 3 small bowel intussusceptions. Twenty patients (91%) were able to be managed entirely laparoscopically or via extension of the umbilical incision, while 2 necessitated conversion, using a right-lower quadrant incision. Nine patients had an extension of the umbilical incision; 7 of these underwent a bowel resection. Ten patients (46%) had a bowel resection, of which 5 were an ileocecectomy and 5 were segmental small bowel resection. There were a total of 9 patients with a pathologic lead point, 5 patients with lymphoid hyperplasia, and 4 with Meckel's diverticula.
Conclusion:
We conclude that laparoscopy is a reasonable approach to pediatric intussusception, even in the event when bowel resection is necessary.
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