title: LAHRI: Laparoscopic-Assisted Hydrostatic Reduction of Intussusception.
abstract: OBJECTIVE
  Intussusception is the most common cause of bowel obstruction in children from 3 months to 3 years of age. In the absence of peritonitis, initial treatment is either hydrostatic or pneumatic reduction. If these measures fail, operative intervention is required. In nonreducible cases, we propose the use of intraoperative hydrostatic enema to achieve or confirm reduction. In this study we describe a cohort of patients who have undergone laparoscopic-assisted hydrostatic reduction of intussusception (LAHRI).
  
  
  METHODS
  This is a retrospective cohort study of all patients undergoing LAHRI from the years 2011 to 2013. We performed LAHRI in seven children 4 months to 2 years of age. All patients had ileocolic intussusception that failed initial reduction by radiographic enema. With the patient under general anesthesia, saline enema reduction was facilitated by direct laparoscopic visualization.
  
  
  RESULTS
  In 2 of the 7 cases, intussusception reduction was visually confirmed in real time, and only a laparoscopic camera port was required. In 1 patient, the bowel was extensively dilated, requiring mini-laparotomy for visualization. The enema, however, reduced the intussusception without any need for manual reduction. In the remaining 4 cases, minimal laparoscopic manipulation was required after the enema failed to completely reduce the intussusceptum, but enema was used to confirm reduction. No child required bowel resection.
  
  
  CONCLUSIONS
  In cases of failed reduction by contrast enema, we have demonstrated LAHRI to be a successful treatment modality. The technique has the advantage of little to no bowel manipulation and has evolved into one performed via a single umbilical port.
authors.affiliation: 1 Department of Surgery, Oregon Health and Science University , Portland, Oregon.
authors.forename: Cristina B
authors.initials: CB
authors.lastname: Geltzeiler
authors.affiliation: 2 Department of Surgery, Nemours Children's Clinic Jacksonville , Jacksonville, Florida.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Sims
authors.affiliation: 1 Department of Surgery, Oregon Health and Science University , Portland, Oregon.|3 Division of Pediatric Surgery, Northwest Permanente , Portland, Oregon.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Zigman
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D004733:Enema / Q000379:methods; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D007077:Ileal Diseases / Q000473:pathology / Q000601:surgery*; D007223:Infant; D007443:Intussusception / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D007813:Laparotomy / Q000379:methods; D008297:Male; D012189:Retrospective Studies