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Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National
Naohiro Takamoto1, Takaaki Konishi2, Michimasa Fujiogi3
1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Insights
Laparoscopic surgery for pediatric intussusception shows similar outcomes to open surgery, including morbidity and recurrence rates. This large study confirms laparoscopic procedures are a safe and acceptable option for treating children with intussusception.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Pediatric intussusception is a common surgical emergency.
- Laparoscopic surgery is increasingly used for intussusception, but its outcomes compared to open surgery require clarification.
Purpose of the Study:
- To compare short-term surgical outcomes and recurrence rates between laparoscopic and open surgery for pediatric intussusception.
Main Methods:
- Retrospective analysis of a Japanese nationwide inpatient database (April 2016-March 2021).
- Included patients aged <18 years who underwent laparoscopic (n=192) or open (n=416) surgery.
- Propensity-score overlap weighting analyses were used to compare outcomes.
Main Results:
- No significant differences were found in in-hospital morbidity, reoperation, or readmission rates between laparoscopic and open surgery.
- Bowel resection, Meckel's diverticulum diagnosis, anesthesia duration, hospital stay, and costs were also comparable.
- The laparoscopic group had fewer congenital malformations and emergency admissions.
Conclusions:
- Laparoscopic surgery is a safe and effective alternative to open surgery for pediatric intussusception.
- No significant differences in key outcomes were observed in this large nationwide cohort.
- Laparoscopic surgery is an acceptable treatment option for pediatric intussusception.
Background:
Laparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception.
Methods:
Patients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs.
Results:
The laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35-2.23]), reoperation (1.88 [0.24-14.9]), readmission for intussusception within 30 days (0.80 [0.12-5.30]) and 1 year (0.90 [0.28-2.93]), bowel resection (0.69 [0.46-1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50-1.90]), duration of anesthesia (difference, 11 [-1-24] minutes), postoperative length of stay (difference, -1.9 [-4.2-0.4] days), or total hospitalization costs (difference, 612 [ -746-1970] US dollars) between the groups.
Conclusions:
In this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception.
Levels Of Evidence:
Level III.
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