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What is the role of laparoscopic surgery in intussusception?
Christoph Heinrich Houben1, Xiang-Nan Feng2, Sheung-Ho Tang2
1Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Insights
Laparoscopic surgery is effective for about half of children needing intussusception reduction. This minimally invasive approach may lead to shorter hospital stays compared to open surgery for intussusception.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Intussusception is a common surgical emergency in children.
- Assessing the role and outcomes of laparoscopic surgery for intussusception is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of laparoscopic surgery in managing pediatric intussusception.
- To compare laparoscopic versus open surgical approaches for intussusception in children.
Main Methods:
- Retrospective review of 44 pediatric patients (up to 17 years) undergoing surgery for intussusception between 2004 and 2013.
- Analysis of initial surgical approach (laparoscopic vs. open), conversion rates, and reasons for conversion.
Main Results:
- 37 patients initially underwent a laparoscopic approach, with 24 (54%) successfully treated. Conversion to open surgery was required in 13 patients due to factors like irreducible intussusception or limited space.
- 20 patients (46%) underwent open surgery, including conversions and primary open cases. Open surgery was more common for distal intussusception and younger infants.
- Patients with completed laparoscopic intervention had shorter hospital stays than those undergoing open surgery (P=0.0145).
Conclusions:
- Laparoscopic intervention is a viable and meaningful option for approximately 50% of pediatric intussusception cases requiring surgical reduction.
- The choice between laparoscopic and open surgery depends on intussusception characteristics and patient factors, with open surgery often reserved for more complex cases.
Background:
Assessing the role of laparoscopy in the management of intussusception.
Methods:
A retrospective review of children aged up to 17 years who had surgery for intussusception at this institution between 1 January 2004 and 31 December 2013.
Results:
The cohort of 44 individuals (18 females) presented at a median age of 9 months (range 2.5 months-15.75 years) with intussusception; 36 patients had undergone a failed pneumatic reduction. Thirty-seven patients had an initial laparoscopic approach. Conversion was required in 13 individuals: inability to reduce a 'tight' intussusception in seven individuals, limited working space in four individuals, and inadequate tactile response in two individuals. Twenty-four patients (54%) had the laparoscopic approach completed. An open approach was chosen for seven individuals at a median age of 5 (range 4-11) months: three individuals had marked abdominal distension, two individuals had a pneumoperitoneum and two individuals presented with a large central mass. Together with the 13 conversions, a total of 20 patients (46%) underwent an open approach. The more distal the apex of the intussusception, the more likely open surgery was. Hospital stays for the subgroup of patients with successfully completed laparoscopic intervention (n = 24) were shorter than for the open surgery group (n = 20) with P = 0.0145, but the open procedure was used to manage the more challenging cases. The subgroup of seven infants undergoing direct open surgery were significantly younger than the remaining individuals (P = 0.0046).
Conclusion:
Laparoscopic intervention is meaningful in approximately 50% of children requiring a surgical reduction.
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