(1)
Neonatal and Paediatric Surgery Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
Abstract
Intussusception is a common abdominal emergency in infants and young children, with a peak incidence between 5 and 7 months of age (70 % of cases present between 3 and 13 months). Treatment is reduction, usually by pneumatic or hydrostatic enema. However, surgery is required when enema reduction fails or there is radiologic indication of doubt or risk regarding reduction. Laparoscopy may be diagnostic, providing confirmation of reduction or persistent intussusception (where doubt exists), or it may be interventional, allowing a minimally invasive approach to reduction. In the event that laparoscopic reduction is unsuccessful, it also enables a focused and minimal incision for open surgery.
Keywords
IntussusceptionLaparoscopyDiagnosisReduction23.1 General Information
Intussusception is a common abdominal emergency in infants and young children, with a peak incidence between 5 and 7 months of age (70 % of cases present between 3 and 13 months). Treatment is reduction, usually by pneumatic or hydrostatic enema. However, surgery is required when enema reduction fails or there is radiologic indication of doubt or risk regarding reduction. Laparoscopy may be diagnostic, providing confirmation of reduction or persistent intussusception (where doubt exists), or it may be interventional, allowing a minimally invasive approach to reduction. In the event that laparoscopic reduction is unsuccessful, it also enables a focused and minimal incision for open surgery.
23.2 Working Instruments
5-mm Instruments (3-mm size can be used for a small infants but may be more traumatic during reduction and handling)
5-mm 30° Scope
5-mm Ports × 2
5-mm Johan graspers (atraumatic)
23.3 Positioning, Port Siting, and Ergonomic Considerations
The patient should be placed with the feet at the end on the table, and the laparoscopic screen should be on the patient’s right side with the freedom to be moved from the head to feet end of the table. This movement may be necessary, depending on the initial position and extent of the intussusceptum (which may be as far as the sigmoid colon or rectum) to allow ergonomic positioning for the initial reduction (Fig. 23.1).
A 5-mm umbilical port position is used for the 30° telescope, and the two lateral 5-mm ports are placed in the right upper quadrant (RUQ) and left lower quadrant (LLQ) of the abdomen, opposite and perpendicular to the course of the mesenteric base (Fig. 23.2).
