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Modified Pneumatic Reduction Protocol for Intussusception: A Retrospective Cohort Study in an Ultrahigh Volume Center
Quang T Nguyen1, Hien D Pham2, Quynh A Tran2
1Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Viet Nam; College of Health Science, VinUniversity, Hanoi, Viet Nam.
Insights
A modified fluoroscopic-guided air-enema reduction (FGAR) protocol for intussusception is safe and effective, showing a high success rate and low recurrence. This approach is promising for pediatric patients in lower-middle-income countries.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Intussusception is a common surgical emergency in children.
- Assessing long-term outcomes of modified pneumatic reduction is crucial, especially in resource-limited settings.
- Vietnam National Hospital of Pediatrics manages a high volume of pediatric intussusception cases.
Purpose of the Study:
- To evaluate the long-term outcomes of a modified fluoroscopic-guided air-enema reduction (FGAR) protocol for intussusception.
- To determine the safety, efficacy, and recurrence rates of this modified FGAR protocol.
- To assess the feasibility of this protocol in a lower-middle-income country context.
Main Methods:
- Retrospective cohort observational study of 3562 patients undergoing modified FGAR from January 2016 to December 2017.
- Data collection included patient demographics, complication rates, and long-term recurrence incidence.
- Follow-up duration was a median of 6 years.
Main Results:
- Modified FGAR achieved a 98.7% success rate with a median procedure time of 4 minutes and a median hospital stay of 1 day.
- Complications included 43 unsuccessful reductions and 4 perforated bowels; 20 patients required ICU admission.
- Over 6 years, 5.6% of patients experienced recurrence, predominantly within the first year. Infants under 12 months had significantly higher complication rates (p < 0.05).
Conclusions:
- The modified FGAR protocol is safe, feasible, and highly effective for pediatric intussusception.
- Low complication and recurrence rates support its clinical utility.
- This protocol represents a promising treatment option for intussusception in low-to-middle-income countries.
Background:
This study aims to assess the long-term outcomes of a modified pneumatic reduction protocol for intussusception at the Vietnam National Hospital of Pediatrics, an institution with a significant patient load in a lower-middle-income country.
Patients And Methods:
A single center, retrospective cohort observational study was conducted to examine patients who underwent modified fluoroscopic-guided air-enema reduction (FGAR) for intussusception from January 2016 to December 2017. Data on patient demographics, complication rates, and the incidence of long-term recurrence was collected.
Results:
Between January 2016 and December 2017, a total of 3562 patients underwent modified FGAR at our institution, including 2313 males (64.9%) and 1249 females (35.1%). The median age was 19 months (range: 1-170), and the median FGAR procedure duration was 4 min (range: 2-24). The median hospital stay was 1 day (range: 1-31). Successful reduction was achieved in 98.7% of cases, with 43 unsuccessful cases and 4 cases of perforated bowel requiring surgery. Twenty patients, presenting with severe symptoms due to delayed treatment seeking, were admitted to the pediatric intensive care unit (ICU) post-FGAR. No mortality or severe morbidity was reported. Over a median 6-year follow-up, intussusception recurred in 198 patients, accounting for 5.6% of the cohort, with 97% of recurrences occurring within the first year post-reduction. Infants and children under 12 months of age had the highest complication rates, including failed FGAR, complicated intussusception, ICU admission, or recurrence, compared to other age groups, and this difference was statistically significant (p < 0.05).
Conclusion:
The modified FGAR protocol has been demonstrated to be safe and feasible, with a very high success rate, low complication rate, and low recurrence rate. Although further comparative studies are needed to confirm its reproducibility, it should be considered a promising approach for children in low-to middle-income countries.
Level Of Evidence:
Level III.
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