Laparoscopic Reduction of Intussusception in Children: Role in Primary Reduction After Failed Non-Surgical Therapies

Intussusception is one of the main abdominal emergencies in children. Its diagnosis is usually based on the clinical features and confirmed either by U/S and /or barium enema and CT scan in rare occasion. Since the introduction of the hydrostatic reduction of intussusceptions by Ravitch in 1848, it became the gold standard management. However surgical intervention is required if this and other non-operative approaches fail. This typically involves 10 to 20% of cases. Early on, the approach has been through an open laparotomy and manual reduction of intussusception. Later, the introduction of the laparoscopy in the paediatric surgical field has added another dimension to the management of intussusception. In addition to its confirmed general benefits of less pain, better cosmoses, and low long-term risk of adhesive bowel obstruction, it also can be a diagnostic modality in certain cases, primary reduce the intussusception and in some cases to resect the pathological lead point or the damaged segment of bowel. The laparoscope allowed the surgeons to avoid unnecessary open procedures in cases of spontaneous reduction following enema reductions, obviating the need for an open procedure in up to 30% of cases. Despite of all mentioned above, its effectiveness has been questioned.