Fraser Jason D, Aguayo Pablo, Ho Brian, Sharp Susan W, Ostlie Daniel J, Holcomb George W, St Peter Shawn D
Department of Surgery, The Children's Mercy Hospital, 2401 Gilham Road, Kansas City, MO 64108, USA.
J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):563-5. doi: 10.1089/lap.2009.0117.
Minimally invasive approaches are beginning to be employed in the management of pediatric patients with intussusception who fail radiographic reduction. Successful laparoscopic reduction has been demonstrated, but the utility of laparoscopy, for more complex cases, is less well documented. Therefore, we reviewed our experience with laparoscopy in patients with radiographically irreducible intussusception to document the safety and effectiveness of this approach.
We conducted a retrospective review of all of the patients who had a radiographically irreducible intussusception treated via the laparoscopic approach at a single institution from 1998 to 2008. Means are expressed +/- standard deviation.
A total of 22 patients were identified, with an average age of 2.9 +/- 3.0 years. Average length of stay was 2.67 +/- 1.5 days (median, 2). Sixteen (73%) of the 22 patients were male. There were 19 ileocecal and 3 small bowel intussusceptions. Twenty patients (91%) were able to be managed entirely laparoscopically or via extension of the umbilical incision, while 2 necessitated conversion, using a right-lower quadrant incision. Nine patients had an extension of the umbilical incision; 7 of these underwent a bowel resection. Ten patients (46%) had a bowel resection, of which 5 were an ileocecectomy and 5 were segmental small bowel resection. There were a total of 9 patients with a pathologic lead point, 5 patients with lymphoid hyperplasia, and 4 with Meckel's diverticula.
We conclude that laparoscopy is a reasonable approach to pediatric intussusception, even in the event when bowel resection is necessary.
