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[Laparoscopy in the management of invagination in pediatric patients]
1Klinika detskej chirurgie Detskej fakultnej nemocnice s poliklinikou a Lekárskej fakulty Univerzity Komenského v Bratislave, Slovenski republiká. pavol.omanik@gmail.com
Insights
Laparoscopic desinvagination is a safe and effective minimally invasive treatment for pediatric intussusception when conservative methods fail. This technique offers a shorter hospital stay and no reported complications, making it a valuable alternative to open surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Procedures
- Gastrointestinal Surgery
Context:
- Intussusception is a common surgical emergency in children.
- Laparoscopic techniques are increasingly adopted in pediatric surgery.
- Previous hydrostatic reduction attempts for intussusception had failed in the studied cohort.
Purpose:
- To establish laparoscopic desinvagination as a standard procedure in a clinical setting.
- To evaluate the efficacy and safety of laparoscopic desinvagination in pediatric patients.
- To compare laparoscopic desinvagination with traditional open surgical revision.
Summary:
- A total of 19 pediatric patients with ileocolonic intussusception underwent surgery after failed hydrostatic reduction.
- Laparoscopic desinvagination was successfully performed in 7 patients (aged 8-51 months) using a three-port technique.
- The mean operative time was 68.6 minutes, with no intraoperative complications, a 4.3-day mean hospitalization, and no recurrence.
Impact:
- Laparoscopic desinvagination provides a viable, less invasive option for refractory intussusception in children.
- Successful implementation of this technique can reduce patient recovery time and hospital stay.
- Experienced laparoscopic surgeons can effectively utilize this minimally invasive approach, potentially avoiding open surgery.
Aim:
During the last decade, many articles on indications, contraindications, benefits and risks of laparoscopic desinvagination procedures in children have been presented in scientific literature. However, this therapeutic procedure has become a standard therapeutic option within the range of pediatric laparoscopic precedures. The aim of the authors was to establish this miniinvasive procedure in their clinic.
Patients And Methods:
From January 2006 to December 2009, the authors operated 19 patients with ileocolonic invaginations, in whom prior hydrostatic desinvagination had failed. 11 pediatric patients underwent laparotomic revision. In 9 subjects, idiopatic invagination was detected, while in 2 subjects secondary intususception caused by a Meckel's diverticle was confirmed during the procedure. In 7 subjects aged 8-51 months, desinvagination was achieved using laparoscopic procedures. 3 ports were used during the procedures--one for optic devices, measuring 10 mm, was placed in the infraumbilical incision and 2 working ports of 5 mm were introduced into the left hypogastrium and the left mesogastrium. The desinvagination was achieved using a grasper and gentle traction on the invaginated colon. In two subjects with relapsing invagination, desinvagination was followed by ileo-coecopexy. In one subject, conversion was required during the laparoscopic procedure, because repositioning of the invaginated colon was not feasible.
Outcomes:
The mean duration of these laparoscopic procedures was 68.6 minutes and no intraoperative complications were recorded. Reallimentation was introduced on the first postoperative day, no reinvagination episodes were recorded and the mean duration of hospitalization was 4.3 days.
Conclusion:
Laparoscopic desinvagination has become a part of the algorithm for the management of invaginations in cases, where conservative approach failed, and should be used before open laparoscopic revision is indicated. However, the miniinvasive procedure must be performed by a surgeon with experience in laparoscopy.
