Laparoscopic vs open surgical approach for intussusception requiring operative intervention

Presented at the 35th Annual Meeting of the American Pediatric Surgical Association, Ponte Vedra, Florida, May 27-30, 2004.
https://doi.org/10.1016/j.jpedsurg.2004.09.026Get rights and content

Abstract

Purpose

Laparoscopy has recently been used to treat intussusception that cannot be reduced radiologically. The effectiveness and practical nature of this approach has been questioned.

Methods

This study retrospectively analyzed the authors' experience with this laparoscopic approach and compared this to the conventional open laparotomy procedure.

Results

Sixteen patients were treated via laparoscopy, with 2 of these requiring conversions to an open procedure (12.5%). Twenty-five patients underwent an open reduction. Operative time was not significantly different (P = .698) between the laparoscopic (49.56 ± 26.40 minutes) and open groups (45.00 ± 24.74). Length of stay, however, was significantly reduced (P = .005) in the laparoscopic group (3.00 ± 1.31 days) compared to the open group (4.52 ± 1.98). Total hospital charges were lower in the laparoscopic group ($8171 ± 2595) compared to the open group ($11,672 ± 5466); this difference was not significant (P = .088). There were no significant differences in intra- or postoperative complication rates (P = .637) between the 2 approaches.

Conclusions

Although there remains a group who will require a conversion to an open procedure, the laparoscopic approach should be considered a safe and effective option for all children who do not respond to a radiological reduction.

Section snippets

Methods

A retrospective study of 42 patients surgically treated for intussusception since 1994 was performed. Data were obtained from our hospital and satellite hospitals covered by our pediatric surgeons. Institutional Review Board approval was obtained from all participating hospitals. Intussusception was diagnosed by either contrast enema or ultrasonography. All patients were referred to our service only after failing radiological reduction. Choice of laparoscopic (LAP) or open (OPN) approach was

Results

The 41 patients who underwent surgical reduction for small bowel intussusception ranged from 1 month to 7 years old. Sixteen patients underwent laparoscopic reduction; 2 (12.5%) of which required conversion to an open procedure. The remaining 25 were handled via the open approach. Based on surgical procedure, 2 groups were established for analysis. Patients treated initially with laparoscopy were placed in the group LAP (n = 16). Patients who underwent laparotomy were placed in the group OPN (n

Discussion

The management of intussusception has not been standardized. Initial diagnosis is usually performed by contrast enema, but air enema and ultrasound are also effective [9], [10], [11]. Nonsurgical attempts at reduction should be the first line of therapy for any intussusception patient unless there are obvious signs of bowel necrosis or perforation. Reduction is considered complete when patency of the ileocecal valve can be demonstrated by contrast material or ultrasound. Unsuccessful

References (17)

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