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Laparoscopy-assisted hydrostatic in situ reduction of intussusception: A reasonable alternative?
V V S S Chandrasekharam1, Suhasini Gazula, Rajendra Prasad Gorthi
1Department of Paediatric Surgery, Gandhi Medical College and Hospital, Hyderabad, Andhra Pradesh, India.
Insights
Laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI) offers a safe and effective method for reducing pediatric intussusceptions. This technique provides controlled reduction in an operating room setting, minimizing complications.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Gastrointestinal surgery
Background:
- Intussusception is a common surgical emergency in children.
- Traditional reduction methods can involve open surgery or less controlled approaches.
- A need exists for minimally invasive and controlled reduction techniques.
Purpose of the Study:
- To evaluate laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI) as an alternative method.
- To assess the safety and efficacy of LAHIRI in pediatric patients.
Main Methods:
- Retrospective observational study of eleven pediatric patients.
- LAHIRI performed under general anesthesia with laparoscopic guidance.
- Warm saline infusion via Foley catheter for reduction.
Main Results:
- Successful reduction in 10 out of 11 patients (90.9%) with ileocolic intussusception.
- One patient required manual reduction for ileo-ileal intussusception.
- Mean operative time was 38.5 minutes; no bowel ischemia or complications observed.
Conclusions:
- LAHIRI is an effective and safe technique for pediatric intussusception reduction.
- Advantages include a controlled environment, reduced patient discomfort, and direct visualization of bowel health.
- This method allows for safe creation of intraluminal pressure and ensures complete reduction.
Aim:
To evaluate an alternative way of reducing intussusceptions under laparoscopic guidance.
Materials And Methods:
This is a retrospective observational study of children who underwent laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI). Under general anesthesia with laparoscopic vision, warm saline was infused into the rectum with a 16-18 F Foley catheter and a drip set till the intussusception was reduced.
Results:
Eleven patients [age 7.8 (±2.8) months] were operated over a period of 1 year. Ten (90.9%) patients had ileocolic intussusception, which got completely reduced, but one (9%) had ileo-ileocolic intusussception, in whom manual reduction by extending the subumbilical incision was required to reduce the ileoileal part. The mean duration of surgery was 38.5 (±6.6) min. No patient had bowel ischemia and there were no intra- or postoperative complications.
Conclusions:
LAHIRI appears to be an effective and safe technique in children. Specific advantages are that it is performed in a controlled environment in the operating room, avoids patient apprehension and discomfort, avoids bowel handling, provides a safe opportunity to create higher intraluminal pressure, ensures visual assessment of bowel vascularity and completeness of reduction.
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