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Yang J, Wang G, Gao J, Zhong X, Gao K, Liu Q, Nan G, Yan C, Chen G, Lu P, Guo C. Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute. Sci Rep 2024; 14:457. [PMID: 38172223 PMCID: PMC10764731 DOI: 10.1038/s41598-023-50493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The optimal treatment for acute intussusception has not yet been defined. In this study, we explored whether employing a liberal laparoscopic intervention for intussusception could lead to favorable outcomes. We performed a historical control analysis to evaluate the outcomes associated with this liberal surgical management protocol. This liberal surgical management protocol were revised to incorporate a new protocol centered around the laparoscopic approach. In some cases of acute intussusception, liberal laparoscopic exploration and intervention were undertaken without initial hydrostatic or pneumatic reduction. During the study interval, a retrospective review was conducted on a total of 3086 patients. These were categorized into two groups: 1338 cases before May 2019 (pre-protocol group) and 1748 cases after May 2019 (post-protocol group). Surgical intervention rates in the pre-protoco and post-protocol period were 10.2% and 27.4% respectively (odds ratio [OR] = 0.30 [95% CI 0.25-0.37]; p < 0.001). No significant differences were observed in baseline clinical characteristics or demographic features between the two groups. The duration from admission to operation was longer for the pre-protocol group (p = 0.008) than for the post-protocol group. The post-protocol group demonstrated decreases in both intestinal resection (OR = 1.50 [95% CI 0.96-2.35]; p = 0.048) and total recurrent events (OR = 1.27 [95% CI 1.04-1.55]; p = 0.012) compared to the pre-protocol group. Liberal laparoscopic intervention for intussusception may effectively reduce the risk of intestinal resection and total recurrent events, thereby exhibiting promising outcomes for patients with intussusception.
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Affiliation(s)
- Jian Yang
- Department of Pediatric General Surgery, Yongchuan Maternal and Child Health Hospital, Chongqing, People's Republic of China
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
| | - Guoyong Wang
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Jia Gao
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
- Department of Pediatrics, Hechuan Maternal and Child Health Hospital, Chongqing, People's Republic of China
| | - Xiaotong Zhong
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Kai Gao
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Qianyang Liu
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Guoxin Nan
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Chengwei Yan
- Department of Pediatrics, Three Gorges Hospital, Chongqing University, Chongqing, People's Republic of China
| | - Gongli Chen
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China
| | - Peng Lu
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China.
| | - Chunbao Guo
- Department of Pediatric General Surgery, Chongqing Health Center for Women and Children, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd, Chongqing, 401147, People's Republic of China.
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Chen X, Chen Q, Wang X, Gao Z. Clinical characteristics of recurrent intussusception: A single-center retrospective study. J Pediatr Surg 2021; 56:1831-1834. [PMID: 33896613 DOI: 10.1016/j.jpedsurg.2021.03.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE we attempted to summarize the clinical characteristics of recurrent intussusception through a large sample size retrospective study. METHODS 5778 patients who were diagnosed with intussusception and treated in our hospital between January 2014 and December 2018 were reviewed. RESULTS the overall recurrence rate was 20.0%, with the recurrence frequency ranged from 1 to 17 episodes and the recurrence interval ranged from 0 to 5 years. 80.0% (926/1158) patients had only 1 to 2 episodes of recurrence. Most of the patients (88.3%) relapsed within 1 year after successful reduction, among which 616 patients (53.2%) relapsed within 3 days. The recurrence rate of intussusception was the lowest when the age was less than 1 year, increased and kept high level in patients aged from 1 to 5 years old, then decreased after 5 years. The pathologic lead point (PLP) proportion of recurrence group was higher than that of non-recurrence group (2.2% VS 1.2%, P = 0.005). CONCLUSIONS the overall recurrence rate was 20.0%. Most of the patients had only 1 to 2 episodes of recurrence and relapsed within 1 year after successful reduction. Age and PLP were risk factors for intussusception recurrence.
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Affiliation(s)
- Xiaoli Chen
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 57 Zhugan Street, Xiacheng District, Hangzhou, Zhejiang, China.
| | - Qingjiang Chen
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiang Wang
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhigang Gao
- Department of General Surgery, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Zhang Y, Wang Y, Zhang Y, Hu X, Li B, Ming G. Laparoscopic Ileopexy Versus Laparoscopic Simple Reduction in Children with Multiple Recurrences of Ileocolic Intussusception: A Single-Institution Retrospective Cohort Study. J Laparoendosc Adv Surg Tech A 2020; 30:576-580. [PMID: 32240037 DOI: 10.1089/lap.2019.0641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Laparoscopy has been widely used in treatment of pediatric intussusception. However, controversy still exists on the best surgical approach for children with multiple recurrences. This cohort study is aimed to compare the efficacy and safety of laparoscopic ileopexy versus laparoscopic simple reduction for treatment of ileocolic intussusception with three or more episodes of recurrence in pediatric patients. Patients and Methods: This study enrolled 74 children with three or more recurrences of ileocolic intussusception treated at our department between January 2016 and June 2018. Of these children, 37 cases undergoing laparoscopic ileopexy were matched with 37 cases undergoing laparoscopic simple reduction according to age. Data on patient characteristics, duration of follow-up, operative parameters, and recurrence rate after laparoscopic operation were reviewed and analyzed. Results: Patient characteristics, including age, gender, weight, number of recurrences at surgery, clinical manifestations, and duration of follow-up, were well comparable between the two groups (each P > .05). During follow-up, recurrence occurred in 16 (43.24%) children undergoing laparoscopic simple reduction, whereas recurrence occurred in 1 (2.70%) case undergoing laparoscopic ileopexy. In comparison, laparoscopic ileopexy significantly decreased the risk of recurrence (P < .001). No statistical difference was observed between the two groups in terms of operative time, length of postoperative stay, and intra- and postoperative complications (each P > .05). No morbidity was documented in both groups. Conclusions: Laparoscopic ileopexy is effective and safe as a surgical approach for multiple recurrences of ileocolic intussusception in pediatric patients. The underlying mechanisms are yet to be fully clarified.
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Affiliation(s)
- Yan Zhang
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiangsu, China
| | - Yujiao Wang
- Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Youcheng Zhang
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiangsu, China
| | - Xiaoting Hu
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiangsu, China
| | - Bing Li
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiangsu, China
| | - Gedong Ming
- Yancheng Maternity and Child Health Care Hospital, Yancheng, Jiangsu, China
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