Pneumatically Assisted Laparoscopic Reduction of Intussusception

Peter SD, Beres AL, Hu YY, Renaud EJ, Ricca R, Slidell MB, Taylor A, Smith CA, Miniati D, Sola JE, Valusek P, Berman L, Raval MV, Gosain A, Dellinger MB, Sømme S, Downard CD, McAteer JP, Kawaguchi A. Management of intussusception in children: A systematic review

OBJECTIVE

The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations for the management of ileocolic intussusception in children.

METHODS

The ClinicalTrials.gov, Embase, PubMed, and Scopus databases were queried for literature from January 1988 through December 2018. Search terms were designed to address the following topics in intussusception: prophylactic antibiotic use, repeated enema reductions, outpatient management, and use of minimally invasive techniques for children with intussusception. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available evidence.

RESULTS

A total of 83 articles were analyzed and included for review. Prophylactic antibiotic use does not decrease complications after radiologic reduction. Repeated enema reductions may be attempted when clinically appropriate. Patients can be safely observed in the emergency department following enema reduction of ileocolic intussusception, avoiding hospital admission. Laparoscopic reduction is often successful.

CONCLUSIONS

Regarding intussusception in hemodynamically stable children without critical illness, pre-reduction antibiotics are unnecessary, non-operative outpatient management should be maximized, and minimally invasive techniques may be used to avoid laparotomy.

LEVEL OF EVIDENCE

Level 3-5 (mainly level 3-4) TYPE OF STUDY: Systematic Review of level 1-4 studies.

Cystoscopy-assisted percutaneous removal of impacted urethral stone: a case report

BACKGROUND AND PURPOSE

Although cystolitholapaxy is possible in children, the instruments are not available everywhere. For tiny impacted urethral stone, an alternate technique is described.

CASE REPORT

A 3-year-old boy came with retention of urine and dysuria. On examination: bladder was full, suprapubic region was tender, and a stone could be felt at posterior urethra. We planned push back and suprapubic cystolithotomy. After general anesthesia, the stone was pushed back by instillation of lignocaine jelly into the urethra. Then, a cystoscope was introduced, and a stone was found inside the urinary bladder. Under cystoscopic view, a 5 mm laparoscopic port was inserted into the bladder just above the pubic symphysis in the midline. A 5 mm tissue holding forceps was introduced through this port, and the tiny stone was grasped and brought out along with the port. The port site was closed by a single stitch. A penile catheter was kept for 5 days.

RESULTS

The boy did well in the postoperative period, and voiding was normal after removal of the catheter.

CONCLUSIONS

Impacted posterior urethral stone can be retrieved by simple percutaneous technique.

Pediatric minimal-access surgery: update 2006

Pediatric patients continue to benefit from the advances made in minimal-access surgery. Improvements in techniques and tools have made minimal-access procedures increasingly available to children. Growing popularity of laparoscopy and thoracoscopy has resulted in greater numbers of patients available for outcomes analysis. Randomized, controlled studies have been difficult to perform because of parent, patient, and physician selection bias.

Current concepts in minimal access surgery for children

Since the introduction of minimal access surgery to general surgeons in the 1980s, pediatric surgeons have been employing this innovative technology to perform surgery on children. Video technology and miniaturized instruments have brought the laboratory to the operating room; in many cases several small incisions are the only access necessary to perform complicated procedures that would otherwise require a large wound. Additional benefits of minimal access surgery may include reduced postoperative analgesic requirements, shortened length of stay, and faster resumption of normal activities. Increased operative costs offset some of these gains. The pediatric surgical community has embraced minimal access techniques for some operations; others remain controversial.