Boehm R, Till H
Department of Pediatric Surgery, University of Munich, Lindwurmstrasse 4, D-80337 Munich, Germany.
Surg Endosc. 2003 May;17(5):831-2. doi: 10.1007/s00464-002-4280-8.
For children with ileocolic intussusceptions, laparoscopy has been proposed as an emergency intervention, but it has not been elaborated for elective prevention of recurrencies. We report about an infant who developed his first ileocolic intussusception at the age of 12 months. Radiologic devagination was successful, but had to be repeated for two consecutive recurrences within several days. Six months later, he presented with another episode of intussusception, which again was managed conservatively. At this time, preventive surgery seemed indicated. Diagnostic laparoscopy using three trocars and 5-mm instruments showed an insufficient closure of the ileocecal valve, allowing the surgeon easily to provoke an intussusception. Consequently, the distal ileum was attached to the ascending colon with several interrupted 3-0 sutures. The infants postoperative course was uneventful. Oral feeding was started immediately, and he could be discharged after 3 days. Within a follow-up period of 1 year, no evidence of intussusception was noted. We conclude that for children with recurrent episodes of intussusception, laparoscopic ileocolonic pexie presents a beneficial strategy for protective surgery.
对于患有回结肠套叠的儿童,腹腔镜检查已被提议作为一种紧急干预措施,但尚未详细阐述其用于择期预防复发的情况。我们报告了一名12个月大时首次发生回结肠套叠的婴儿。放射学复位成功,但在几天内连续两次复发,不得不再次进行复位。六个月后,他再次出现套叠发作,再次采用保守治疗。此时,预防性手术似乎是必要的。使用三个套管针和5毫米器械进行的诊断性腹腔镜检查显示回盲瓣闭合不全,外科医生很容易诱发套叠。因此,用几根3-0间断缝线将回肠末端与升结肠固定。婴儿术后恢复顺利。术后立即开始经口喂养,3天后出院。在1年的随访期内,未发现套叠迹象。我们得出结论,对于复发性套叠患儿,腹腔镜回结肠固定术是一种有益的保护性手术策略。