Laparoscopic treatment of intussusception in children: a systematic review.
BACKGROUND
Idiopathic intussusception is one of the most common causes of small bowel obstruction in children. In the event of failed radiological reduction, laparotomy remains the treatment of choice. There is still no agreement in pediatric surgery about safety and effectiveness of the use of minimally invasive surgery in this common pediatric condition. By reviewing available data we aimed to establish whether laparoscopy should be the primary technique in the surgical reduction of intussusception.


METHODS
A systematic review of all publications on the laparoscopic treatment of pediatric intussusception from January 1990 to April 2012 was performed. The following variables were analyzed: age, laparoscopic success rate, reason for conversion, enterotomy rate, operative time, complications, and length of stay (LOS).


RESULTS
Ten retrospective studies treating 276 cases of laparoscopically reduced intussusception were identified. A total of 80 conversions corresponded to a 71.0% laparoscopic success rate. Only one case of intraoperative iatrogenic intestinal perforation was reported (0.4%). Postoperative complications occurred in 8 patients (2.9%), and adhesive small bowel obstruction was reported in 1 case (0.4%). Recurrence rate after laparoscopy was 3.6%. Three of 10 papers compared results between laparoscopic and open reduction of intussusception showing a shorter mean LOS in the former group (4.0 vs. 7.1 days, p<0.01).


CONCLUSIONS
Laparoscopy is safe and effective in the treatment of pediatric intussusception. Tertiary centers with adequate minimally invasive skills should establish laparoscopy as the primary surgical technique in the treatment of this condition.
Kinderchirurgische Klinik, Dr. von Haunersches Kinderspital, Munich, Germany.
Nadja
N
Apelt
Neil
N
Featherstone
Stefano
S
Giuliani
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D007443:Intussusception / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D000267:Tissue Adhesions / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome
Children; Intussusception; Laparoscopy; Treatment