Minimally invasive approach in the management of childhood intussusception.
BACKGROUND
Intussusception is one of the most common causes of intestinal obstruction in infancy. Non-operative reduction using air enema or other hydrostatic reduction methods has been the standard treatment in most cases. However, if the non-operative method is not indicated or fails, open surgery is still necessary. With the tremendous development of the minimally invasive approach in handling surgical conditions in children in the last decade, this has been applied recently for the reduction of intussusception in children. We herein reviewed our experience of using the combined approach, namely, pneumatic reduction and, if failed, laparoscopic reduction in the management of childhood intussusception.


METHODS
We carried out a retrospective analysis of all children with intussusception managed at Prince of Wales Hospital between December 1998 and December 2004. The minimally invasive approach was used as far as possible. The method of reduction, success rate and the incidence of complication were analysed.


RESULTS
Over a 6-year period, there were 146 patients with 167 episodes of intussusception. Pneumatic reduction was carried out in 160 occasions and was successful in 134 (83.8%). In 33 patients, operative reduction was required. Of these, laparoscopic reduction was attempted in 15 and was successful in 13 (86.7%). In those with either pneumatic or laparoscopic reduction, no procedure-related complication was encountered and they had a significant shorter hospital stay (median 3.0 day) than those requiring laparotomy (median 8.0 day) (t-test, P < 0.0001).


CONCLUSIONS
The minimally invasive approach, that is, pneumatic and/or laparoscopic reduction, was successful in reducing intussusception in 88% of patients with minimal morbidity and shorter hospital stay.
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. gloriacst@yahoo.com.bk
Sing T
ST
Cheung
Kim H
KH
Lee
Tse H
TH
Yeung
Cheong Y
CY
Tse
Yuk H
YH
Tam
Kin W
KW
Chan
Chung K
CK
Yeung
D002648:Child; D002675:Child, Preschool; D004733:Enema; D005260:Female; D006801:Humans; D007223:Infant; D007443:Intussusception / Q000601:surgery / Q000628:therapy*; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies