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Laparoscopic versus open reduction of intussusception in children: experience over a decade
Sarah J Hill1, Curt S Koontz, Simone M Langness
1Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Insights
Laparoscopic surgery for pediatric intussusception is safe and effective, leading to shorter hospital stays and reduced narcotic use compared to open surgery. This minimally invasive approach offers significant benefits for young patients requiring bowel obstruction treatment.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Intussusception is a frequent cause of bowel obstruction in children.
- Surgical intervention may be necessary for reduction or resection.
Purpose of the Study:
- To compare laparoscopic (LAP) versus open (OPEN) surgical approaches for intussusception reduction.
- To evaluate operative outcomes and patient recovery between the two surgical techniques.
Main Methods:
- Retrospective review of 92 pediatric patients undergoing surgical reduction for intussusception over 10 years.
- Comparison of outcomes between patients treated laparoscopically and those treated with open laparotomy.
- Statistical analysis using Wilcoxon rank sum and chi-squared tests (P≤.05 significance).
Main Results:
- Laparoscopic group (65 patients) showed significantly shorter operative time, hospital stay, time to full feeds, and narcotic use compared to the open group (27 patients).
- Conversion to open surgery was required in 21 LAP cases; 6 necessitated bowel resection.
- Pathologic lead points were found in 14% of LAP and 15% of OPEN cases, with 33% in converted LAP cases.
- Complication rates were comparable between laparoscopic and open procedures.
Conclusions:
- Laparoscopic surgery is a safe and effective method for pediatric intussusception reduction.
- Laparoscopic approach offers advantages including reduced operative time, faster feeding resumption, less narcotic requirement, and earlier discharge.
Background:
Intussusception is a common cause of bowel obstruction in children, which sometimes necessitates operative reduction and or resection. We report our series of patients with intussusception who were treated laparoscopically (LAP group) compared with exploratory laparotomy (OPEN group).
Subjects And Methods:
After institutional review board approval, a retrospective review was performed evaluating outcomes for patients requiring surgical reduction of intussusception over a 10-year period. Analysis was based on intent to treat, and technique of exploration was surgeon's choice. Data were analyzed with the Wilcoxon rank sum test and chi-squared test where appropriate. P≤.05 was considered significant.
Results:
During the time period studied, there were 92 patients treated surgically for intussusception: 65 LAP and 27 OPEN. Conversion to the open procedure was required for 21 patients in the LAP group, and of those, 6 required bowel resection. Seven of the patients who were started in the OPEN group ultimately required bowel resection. Operative time, length of hospital stay, time to full feeds, and total days of narcotics were all significantly shorter for the LAP group compared with the OPEN group (P=.003, P=.001, P=.001, and P=.004, respectively). A pathologic lead point was found in 14% of LAP and 15% of OPEN cases. In a subset analysis, 33% of patients who were converted from the LAP group to the open procedure had a pathologic lead point. Complication rates between the LAP and OPEN groups were comparable.
Conclusions:
Laparoscopy appears to be a safe and effective technique for reducing intussusception in children. The laparoscopic cases had shorter operative time, shorter time to full feeds, lower requirement for intravenous narcotics, and earlier discharges.
