Journal of Minimally Invasive Surgery

The Korean Society of Endoscopic & Laparoscopic Surgeons (대한내시경복강경외과학회)
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Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

  • Song, Eun Ju (Department of Surgery, Dong-A University College of Medicine, Dong-A Medical Center) ;
  • Nam, So Hyun (Department of Surgery, Dong-A University College of Medicine, Dong-A Medical Center)
  • Received : 2018.06.15
  • Accepted : 2018.08.27
  • Published : 2018.12.15
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Abstract

Purpose: Intussusception is a common cause of intestinal obstruction in children. While most patients can be treated by enema reduction, about 20% require surgery. We investigated the usefulness and feasibility of laparoscopic surgery and the intraoperative risk of bowel resection. Methods: We retrospectively reviewed pediatric patients who underwent surgery for intussusception from 2010 to 2017. We collected data for age, gender, body weight, associated symptoms, duration of symptoms, white blood cell count, operating time, and postoperative complications. Results: Of 155 patients, 37 (23.8%) underwent surgery due to enema reduction failure in 29 (78.3%), recurrence in 6 (16.3%), a suspicious lead point in 1, and suspicious ischemic change observed on ultrasonography in 1. The mean age was $26.8{\pm}18.9$ months (range, 3.5~76.7 months), and the mean body weight was $12.9{\pm}3.9kg$ (range, 5.4~22.2 kg). Laparoscopic surgery was successful in 29 patients (78.4%), and 7 (18.9%) needed bowel resection and anastomosis. The mean operating time was $56.7{\pm}32.8min$. A lead point was found in 3 patients in the bowel resection group (p=0.005); in addition, the operating time and hospital stay were longer in this group. There were no intra- or postoperative complications. Conclusion: Laparoscopic surgery was successful in 78.4% of the patients with a short hospital stay and early oral intake. The only predictive factor for bowel resection was the presence of a lead point. Laparoscopic surgery may be an optimal treatment intervention for children with intussusception, except for those who show initial peritonitis.

Keywords

Acknowledgement

Supported by : Dong-A University

References

  1. Parashar UD, Holman RC, Cummings KC, et al. Trends in intussusception-associated hospitalizations and deaths among US infants. Pediatrics 2000;106:1413-1421. https://doi.org/10.1542/peds.106.6.1413
  2. Seifarth FG, Ryan ML, Triana J, Knight CG. Diagnosis and laparoscopic treatment of ileoileal intussusception secondary to heterotopic pancreas in an infant: case report and review of the literature. J Pediatr Surg 2011;46:e33-e36.
  3. Fallon SC, Lopez ME, Zhang W, et al. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013;48:1032-1036. https://doi.org/10.1016/j.jpedsurg.2013.02.021
  4. Arbizu RA, Aljomah G, Kozielski R, Baker SS, Baker RD. Intussusception associated with adenovirus. J Pediatr Gastroenterol Nutr 2014;59:e41. https://doi.org/10.1097/MPG.0b013e3182868971
  5. Savoie KB, Thomas F, Nouer SS, Langham MR, Jr., Huang EY. Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study. Surgery 2017;161:995-1003. https://doi.org/10.1016/j.surg.2016.09.030
  6. Ha H, Cho J, Park J. Risk Factors Associated with the Need for Operative Treatment of Intussusception in Children. J Korean Assoc Pediatr Surg 2014;20:17-22. https://doi.org/10.13029/jkaps.2014.20.1.17
  7. Ravitch MM, McCune RM, Jr. Reduction of Intussusception by Barium Enema : A Clinical and Experimental Study. Ann Surg 1948;128:904-917. https://doi.org/10.1097/00000658-194811000-00003
  8. van der Laan M, Bax NM, van der Zee DC, Ure BM. The role of laparoscopy in the management of childhood intussusception. Sugr Endosc 2001;15:373-376. https://doi.org/10.1007/s004640090044
  9. Bratton SL, Haberkern CM, Waldhausen JH, Sawin RS, Allison JW. Intussusception: hospital size and risk of surgery. Pediatrics 2001;107:299-303. https://doi.org/10.1542/peds.107.2.299
  10. Kia KF, Mony VK, Drongowski RA, et al. Laparoscopic vs open surgical approach for intussusception requiring operative intervention. J Pediatr Surg 2005;40:281-284. https://doi.org/10.1016/j.jpedsurg.2004.09.026
  11. Schier F. Experience with laparoscopy in the treatment of intussusception. J Pediatr Surg 1997;32:1713-1714. https://doi.org/10.1016/S0022-3468(97)90512-1
  12. Hay SA, Kabesh AA, Soliman HA, Abdelrahman AH. Idiopathic intussusception: the role of laparoscopy. J Pediatr Surg 1999;34:577-578. https://doi.org/10.1016/S0022-3468(99)90077-5
  13. Fraser JD, Aguayo P, Ho B, et al. Laparoscopic management of intussusception in pediatric patients. J Laparoendosc Adv Surg Tech A 2009;19:563-565. https://doi.org/10.1089/lap.2009.0117
  14. Bonnard A, Demarche M, Dimitriu C, et al. Indications for laparoscopy in the management of intussusception: A multicenter retrospective study conducted by the French Study Group for Pediatric Laparoscopy (GECI). J Pediatr Surg 2008;43:1249-1253. https://doi.org/10.1016/j.jpedsurg.2007.11.022
  15. Burjonrappa SC. Laparoscopic reduction of intussusception: an evolving therapeutic option. JSLS 2007;11:235-237.
  16. Apelt N, Featherstone N, Giuliani S. Laparoscopic treatment of intussusception in children: a systematic review. J Pediatr Surg 2013;48:1789-1793. https://doi.org/10.1016/j.jpedsurg.2013.05.024
  17. Wei CH, Fu YW, Wang NL, Du YC, Sheu JC. Laparoscopy versus open surgery for idiopathic intussusception in children. Surg Endosc 2015;29:668-672. https://doi.org/10.1007/s00464-014-3717-1
  18. Houben CH, Feng XN, Tang SH, Chan EK, Lee KH. What is the role of laparoscopic surgery in intussusception? ANZ J Surg 2016;86:504-508. https://doi.org/10.1111/ans.13435
  19. Ntoulia A, Tharakan SJ, Reid JR, Mahboubi S. Failed Intussusception Reduction in Children: Correlation Between Radiologic, Surgical, and Pathologic Findings. AJR Am J Roentgenol 2016;207:424-433. https://doi.org/10.2214/AJR.15.15659
  20. Park BC, Kim SY, Jung SJ. A Comparative Analysis of Clinical Features and Treatment Outcomes of Intussusception according to Age Distribution. Korean J Pediatr Gastroenterol Nutr 2005;8:105-156.
  21. Cheung ST, Lee KH, Yeung TH, et al. Minimally invasive approach in the management of childhood intussusception. ANZ J Surg 2007;77:778-781. https://doi.org/10.1111/j.1445-2197.2007.04228.x
  22. Bailey KA, Wales PW, Gerstle JT. Laparoscopic versus open reduction of intussusception in children: a single-institution comparative experience. J Pediatr Surg 2007;42:845-848. https://doi.org/10.1016/j.jpedsurg.2006.12.037
  23. Almaramhy HH. Laparoscopic reduction of intussusception in children: role in primary and revisional reduction after faile dnonsurgical therapies. Int J Health Sci (Qassim) 2011;5:71-78.
  24. Ein HE, Daneman A. Intussusception. In: Grosfeld JL, O'Neill JA, Coran AG, Fonkalsrud EW, editors. Pediatric surgery. 6th ed. Philadelphia: Mosby Elsevier; 2006. p.1313-1341.
  25. Kornecki A, Daneman A, Navarro O, Connolly B, Manson D, Alton DJ. Spontaneous reduction of intussusception: clinical spectrum, management and outcome. Pediatr Radiol 2000;30:58-63. https://doi.org/10.1007/s002470050015