Intussusception surgery: Difference between revisions

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==Overview==
==Overview==
[[Surgery]] is not the first-line treatment option for patients with intussusception. [[Surgery]] is usually reserved for patients with either unstable patient, [[Gastrointestinal perforation|intestinal perforation]], [[peritonitis]], a mass lesion and patients in whom medical therapy was completely unstable. Technique includes [[intravenous fluid]] resuscitation, [[nasogastric tube]] decompression and use of [[Laparoscopic surgery|laparoscopy]]. Benefits of [[laparoscopy]] include accurate [[diagnosis]], rapid recovery and minimal use of [[narcotic]] [[analgesia]] post-operatively.
==Surgery==
==Surgery==
If the intussusception cannot be reduced by an [[enema]] or if the [[[intestine]] is damaged, then a surgical reduction is necessary. In a surgical reduction, the abdomen is opened and the part that has telescoped in is pulled out manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damaged, the affected section will be resected. Often, the intussusception can be reduced by [[laparoscopy]], whereby the segments of intestine are pulled apart by forceps.
* Indications of surgical intervention include:
** Unstable patient
** Stable patient: when non-operative reduction is completely unsuccessful
** [[Intestinal perforation]]
** [[Peritonitis]]
** A mass lesion - Imaging shows a persistent focal filling defect<ref name="pmid8308683">{{cite journal |vauthors=Pierro A, Donnell SC, Paraskevopoulou C, Carty H, Lloyd DA |title=Indications for laparotomy after hydrostatic reduction for intussusception |journal=J. Pediatr. Surg. |volume=28 |issue=9 |pages=1154–7 |year=1993 |pmid=8308683 |doi= |url=}}</ref>
* '''Technique'''
** [[Intravenous fluid]] [[resuscitation]]
** [[Prophylactic]] [[antibiotics]] covering [[enteric]] [[flora]]
** [[Nasogastric tube]] decompression if the patient has [[nausea]] and [[emesis]]
** Pediatric surgeons prefer [[Minimally invasive procedure|minimally invasive approach]] through [[Laparoscopic surgery|laproscopy]]
** Benefits of laproscopy are:<ref name="pmid17685958">{{cite journal |vauthors=Cheung ST, Lee KH, Yeung TH, Tse CY, Tam YH, Chan KW, Yeung CK |title=Minimally invasive approach in the management of childhood intussusception |journal=ANZ J Surg |volume=77 |issue=9 |pages=778–81 |year=2007 |pmid=17685958 |doi=10.1111/j.1445-2197.2007.04228.x |url=}}</ref><ref><nowiki><ref name="pmid23327343"></nowiki>{{cite journal |vauthors=Hill SJ, Koontz CS, Langness SM, Wulkan ML |title=Laparoscopic versus open reduction of intussusception in children: experience over a decade |journal=J Laparoendosc Adv Surg Tech A |volume=23 |issue=2 |pages=166–9 |year=2013 |pmid=23327343 |doi=10.1089/lap.2012.0174 |url=}}</ref><ref name="pmid24987845">{{cite journal |vauthors=Sklar CM, Chan E, Nasr A |title=Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis |journal=J Laparoendosc Adv Surg Tech A |volume=24 |issue=7 |pages=518–22 |year=2014 |pmid=24987845 |doi=10.1089/lap.2013.0415 |url=}}</ref><ref name="pmid26699630">{{cite journal |vauthors=Houben CH, Feng XN, Tang SH, Chan EK, Lee KH |title=What is the role of laparoscopic surgery in intussusception? |journal=ANZ J Surg |volume=86 |issue=6 |pages=504–8 |year=2016 |pmid=26699630 |doi=10.1111/ans.13435 |url=}}</ref>
*** [[Laproscopic surgery]] allows accurate [[diagnosis]] and reduction of intussusception
*** Rapid recovery
*** Minimal use of [[narcotic]] [[analgesia]] post-operatively
** Reduction is successful in most cases 
** Primary anastomosis is done if manual reduction is not successful
** Primary anastomosis is also done if there is a pathologic lead point 
* Recurrence can occurs is less than 1% cases<ref name="pmid9159862">{{cite journal |vauthors=Madonna MB, Boswell WC, Arensman RM |title=Acute abdomen. Outcomes |journal=Semin. Pediatr. Surg. |volume=6 |issue=2 |pages=105–11 |year=1997 |pmid=9159862 |doi= |url=}}</ref>   
 
==References==
{{reflist|2}}
 
[[Category:Gastroenterology]]
[[Category:Surgery]]
 
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Latest revision as of 18:25, 10 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]

Overview

Surgery is not the first-line treatment option for patients with intussusception. Surgery is usually reserved for patients with either unstable patient, intestinal perforation, peritonitis, a mass lesion and patients in whom medical therapy was completely unstable. Technique includes intravenous fluid resuscitation, nasogastric tube decompression and use of laparoscopy. Benefits of laparoscopy include accurate diagnosis, rapid recovery and minimal use of narcotic analgesia post-operatively.

Surgery

References

  1. ↑ Pierro A, Donnell SC, Paraskevopoulou C, Carty H, Lloyd DA (1993). "Indications for laparotomy after hydrostatic reduction for intussusception". J. Pediatr. Surg. 28 (9): 1154–7. PMID 8308683.
  2. ↑ Cheung ST, Lee KH, Yeung TH, Tse CY, Tam YH, Chan KW, Yeung CK (2007). "Minimally invasive approach in the management of childhood intussusception". ANZ J Surg. 77 (9): 778–81. doi:10.1111/j.1445-2197.2007.04228.x. PMID 17685958.
  3. ↑ <ref name="pmid23327343">Hill SJ, Koontz CS, Langness SM, Wulkan ML (2013). "Laparoscopic versus open reduction of intussusception in children: experience over a decade". J Laparoendosc Adv Surg Tech A. 23 (2): 166–9. doi:10.1089/lap.2012.0174. PMID 23327343.
  4. ↑ Sklar CM, Chan E, Nasr A (2014). "Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis". J Laparoendosc Adv Surg Tech A. 24 (7): 518–22. doi:10.1089/lap.2013.0415. PMID 24987845.
  5. ↑ Houben CH, Feng XN, Tang SH, Chan EK, Lee KH (2016). "What is the role of laparoscopic surgery in intussusception?". ANZ J Surg. 86 (6): 504–8. doi:10.1111/ans.13435. PMID 26699630.
  6. ↑ Madonna MB, Boswell WC, Arensman RM (1997). "Acute abdomen. Outcomes". Semin. Pediatr. Surg. 6 (2): 105–11. PMID 9159862.

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