title: Pediatric postoperative intussusception in the minimally invasive surgery era: a 13-year, single center experience.
abstract: BACKGROUND
  Postoperative intussusception (POI) is a sporadic complication whose mechanisms and risk factors remain poorly understood. Its epidemiology in the minimally invasive surgery era has yet to be well described, particularly in children. We sought to examine risk factors, demographics, and anatomic patterns of pediatric POI in recent years.
  
  
  METHODS
  This was a 13-year retrospective review from a single tertiary pediatric center. Variables analyzed included patient demographics, time of occurrence, type of intussusception, type of anesthesia, and triggering surgical procedure. The latter variable was divided into 2 groups: abdominal and nonabdominal interventions. Statistical analysis was by 2-tailed Fisher's exact test with significance set at p < 0.05.
  
  
  RESULTS
  Among 822 cases of intussusception in 718 patients, 22 documented cases of POI were identified. Twelve of them occurred after abdominal procedures; there was a statistically significant difference in the incidence of POI after open surgery (0.091%; 11 of 12,126) when compared with minimally invasive interventions (0.013%; 1 of 7,610; p = 0.036). As expected, ileoileal and jejunojejunal intussusceptions were the most common forms of POI after abdominal operations (12 of 12; 100%); however, ileocolic intussusceptions were common forms of POI after nonabdominal cases (5 of 10; 50%; p = 0.01). Epidural anesthesia did not appear to be a risk factor for POI.
  
  
  CONCLUSIONS
  Although rare, postoperative intussusception can occur after a multitude of interventions, including those performed at a distance from the abdomen. Although small bowel intussusception is the predominant variant of this complication after abdominal procedures, ileocolic intussusception is prevalent after other interventions. Minimally invasive abdominal access may protect against postoperative intussusception in children.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Klein
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Turner
authors.forename: Sophia C
authors.initials: SC
authors.lastname: Kamran
authors.forename: Alvin Y C
authors.initials: AY
authors.lastname: Yu
authors.forename: Lynne
authors.initials: L
authors.lastname: Ferrari
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Dario O
authors.initials: DO
authors.lastname: Fauza
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007443:Intussusception / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors