The Role of Laparoscopic Reduction in Treating Intussusception
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概要
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Purpose: Intussusception is one of the most common causes of bowel obstruction in infancy and childhood. About 20% of the cases require operative reduction after failing enema reduction. We started a laparoscopic approach from 2008, and reviewed our experience of this approach in the management of intussusception. Methods: A retrospective analysis was conducted for all patients undergoing surgical reduction for intussusception at our institution from October 2008 to October 2011. We evaluated the patients demographics, diagnosis, conversion to laparotomy, and complications. Results: There were 76 cases of intussusception. Hydrostatic reduction was carried out in all 76 cases and was successful in 60 (78.9%). In 16 cases, operative reduction was required. One of these cases, which had an ileal perforation at the enema, underwent open laparotomy. Laparoscopic reduction was attempted in 15 and was successful in 10 (66.6%) cases. Two of these 10 cases had ileoileal intussusception with malignant lymphoma as the lead point. Laparoscopically assisted segmental ileal resection was performed extracorporeally, exteriorizing the ileum through an extended umbilical incision. Five cases could not be reduced by laparoscopy. Three of five cases could be managed via extension of an umbilical incision, while 2 necessitated conversion using a right-lower quadrant incision. As these 5 cases could not be reduced by open Hutchinsons maneuver, all cases were resorted to bowel resection. Operative findings revealed intestinal necrosis in three cases: the lead point as malignant lymphoma in one and Meckels diverticulum in another one. Conclusion: Intussusception can be treated using a laparoscopic manner for stable patients requiring surgical intervention. Laparoscopic reduction of intussusception is feasible and safe.
- 特定非営利活動法人 日本小児外科学会の論文
特定非営利活動法人 日本小児外科学会 | 論文
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