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Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute
Jian Yang1,2, Guoyong Wang2,3, Jia Gao3,4
1Department of Pediatric General Surgery, Yongchuan Maternal and Child Health Hospital, Chongqing, People's Republic of China.
Insights
A liberal laparoscopic approach for acute intussusception may improve outcomes. This strategy reduced intestinal resection and recurrent events compared to previous methods, showing promising results for patient care.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- The optimal treatment for acute intussusception remains undefined.
- A liberal surgical management protocol was revised to emphasize a laparoscopic approach.
Purpose of the Study:
- To evaluate the outcomes of a liberal laparoscopic intervention for acute intussusception.
- To compare outcomes before and after implementing a new laparoscopic-centered protocol.
Main Methods:
- Historical control analysis of 3086 patients with acute intussusception.
- Categorization into pre-protocol (n=1338) and post-protocol (n=1748) groups based on May 2019.
- Retrospective review of clinical characteristics, surgical intervention rates, and outcomes.
Main Results:
- Surgical intervention rates increased in the post-protocol group (27.4%) versus the pre-protocol group (10.2%).
- The post-protocol group showed decreased rates of intestinal resection and total recurrent events.
- No significant differences in baseline clinical or demographic features were noted between groups.
Conclusions:
- A liberal laparoscopic intervention strategy for acute intussusception appears effective.
- This approach may reduce the risk of intestinal resection and recurrence.
- Liberal laparoscopy shows promising outcomes for managing intussusception.
Abstract:
The optimal treatment for acute intussusception has not yet been defined. In this study, we explored whether employing a liberal laparoscopic intervention for intussusception could lead to favorable outcomes. We performed a historical control analysis to evaluate the outcomes associated with this liberal surgical management protocol. This liberal surgical management protocol were revised to incorporate a new protocol centered around the laparoscopic approach. In some cases of acute intussusception, liberal laparoscopic exploration and intervention were undertaken without initial hydrostatic or pneumatic reduction. During the study interval, a retrospective review was conducted on a total of 3086 patients. These were categorized into two groups: 1338 cases before May 2019 (pre-protocol group) and 1748 cases after May 2019 (post-protocol group). Surgical intervention rates in the pre-protoco and post-protocol period were 10.2% and 27.4% respectively (odds ratio [OR] = 0.30 [95% CI 0.25-0.37]; p < 0.001). No significant differences were observed in baseline clinical characteristics or demographic features between the two groups. The duration from admission to operation was longer for the pre-protocol group (p = 0.008) than for the post-protocol group. The post-protocol group demonstrated decreases in both intestinal resection (OR = 1.50 [95% CI 0.96-2.35]; p = 0.048) and total recurrent events (OR = 1.27 [95% CI 1.04-1.55]; p = 0.012) compared to the pre-protocol group. Liberal laparoscopic intervention for intussusception may effectively reduce the risk of intestinal resection and total recurrent events, thereby exhibiting promising outcomes for patients with intussusception.
