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      Laparoscopy-assisted hydrostatic in situ reduction of intussusception: A reasonable alternative?

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          Abstract

          Aim:

          To evaluate an alternative way of reducing intussusceptions under laparoscopic guidance.

          Materials and Methods:

          This is a retrospective observational study of children who underwent laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI). Under general anesthesia with laparoscopic vision, warm saline was infused into the rectum with a 16-18 F Foley catheter and a drip set till the intussusception was reduced.

          Results:

          Eleven patients [age 7.8 (±2.8) months] were operated over a period of 1 year. Ten (90.9%) patients had ileocolic intussusception, which got completely reduced, but one (9%) had ileo-ileocolic intusussception, in whom manual reduction by extending the subumbilical incision was required to reduce the ileoileal part. The mean duration of surgery was 38.5 (±6.6) min. No patient had bowel ischemia and there were no intra- or postoperative complications.

          Conclusions:

          LAHIRI appears to be an effective and safe technique in children. Specific advantages are that it is performed in a controlled environment in the operating room, avoids patient apprehension and discomfort, avoids bowel handling, provides a safe opportunity to create higher intraluminal pressure, ensures visual assessment of bowel vascularity and completeness of reduction.

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          Most cited references13

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          Laparoscopic vs open surgical approach for intussusception requiring operative intervention.

          Laparoscopy has recently been used to treat intussusception that cannot be reduced radiologically. The effectiveness and practical nature of this approach has been questioned. This study retrospectively analyzed the authors' experience with this laparoscopic approach and compared this to the conventional open laparotomy procedure. Sixteen patients were treated via laparoscopy, with 2 of these requiring conversions to an open procedure (12.5%). Twenty-five patients underwent an open reduction. Operative time was not significantly different (P = .698) between the laparoscopic (49.56 +/- 26.40 minutes) and open groups (45.00 +/- 24.74). Length of stay, however, was significantly reduced (P = .005) in the laparoscopic group (3.00 +/- 1.31 days) compared to the open group (4.52 +/- 1.98). Total hospital charges were lower in the laparoscopic group ($8171 +/- 2595) compared to the open group ($11,672 +/- 5466); this difference was not significant (P = .088). There were no significant differences in intra- or postoperative complication rates (P = .637) between the 2 approaches. Although there remains a group who will require a conversion to an open procedure, the laparoscopic approach should be considered a safe and effective option for all children who do not respond to a radiological reduction.
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            Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients.

            The nonoperative management of intussusception continues to evolve and is the subject of ongoing debate. Our purpose was to assess our current enema reduction rate and to focus on two specific issues that have received little attention in the literature: first, the value and safety of using delayed, repeated reduction attempts and, second, the management of intussusceptions due to lead points. We performed a retrospective analysis of all intussusception cases seen at the Hospital for Sick Children, Toronto, Canada, a tertiary pediatric hospital, from May 1999 to December 2002. There were 163 children with a total of 219 intussusceptions. Enema reduction was attempted in 211 (96%). Reduction rate with air enema was 90.2%. Delayed reduction attempts were used in 25 patients (15.3%) in 26 intussusceptions (12.3%) and were successful in 50% of the cases. Lead points were documented in 13 children (8%); sonography depicted the lead points in seven (53.8%) of the 13. The reduction rate of intussusceptions due to lead points was 63.6% (14/22). Air enema associated with the use of delayed, repeated reduction attempts is a safe and effective approach for intussusception reduction with a high success rate. Delayed, repeated reduction attempts should be considered when the initial attempt manages to move the intussusceptum and the patient remains clinically stable. The management of intussusceptions due to lead points remains a challenge. Sonography does not depict all lead points, and the indication for other imaging studies should be tailored according to each particular patient. We recommend attempted enema reduction in all patients with lead points.
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              Laparoscopic surgery in children.

              P Tam (2000)
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                Author and article information

                Journal
                J Indian Assoc Pediatr Surg
                JIAPS
                Journal of Indian Association of Pediatric Surgeons
                Medknow Publications & Media Pvt Ltd (India )
                0971-9261
                1998-3891
                Jan-Mar 2011
                : 16
                : 1
                : 8-10
                Affiliations
                [1]Department of Paediatric Surgery, Gandhi Medical College and Hospital, Hyderabad, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Suhasini Gazula, House No. 11-1-907/1/2, Chilkalaguda, Secunderabad - 500 061, Andhra Pradesh, India suhasinigazula@ 123456gmail.com
                Article
                JIAPS-16-8
                10.4103/0971-9261.74513
                3047778
                21430840
                db5a9f19-da0b-4542-ae17-40f2dbf04cc6
                Copyright: © Journal of Indian Association of Pediatric Surgeons

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Surgery
                intussusceptions,hydrostatic reduction,laparoscopy
                Surgery
                intussusceptions, hydrostatic reduction, laparoscopy

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