Reduction of intussusception in infants by a pediatric surgical team: improvement in safety and outcome

Commonly, reduction of intussusception is performed by experienced radiologists. We review the performance of a pediatric surgical team for treating intussusception according to a standard protocol and present our findings. Three hundred and seventy eight patients with signs and symptoms of intussusception we treated from 1980 to 2005 were reviewed. Hydrostatic reduction (HR) was performed using a water-soluble contrast agent under fluoroscopy unless there was a serious condition clinically. Before 1998, HR was performed exclusively by pediatric surgical trainees (period A). In 1998, a standard protocol (double-balloon tube, maximum pressure of 120 cmH(2)O, repeated a maximum of five times, and HR performed by a pediatric surgical trainee under the supervision of a consultant pediatric surgeon) was adopted (period B). As part of the protocol, the operating room was notified of the HR procedure and placed on call for emergency surgery. Of the 378 patients, 21 required immediate laparotomy due to serious general condition, leaving 138 during period A and 219 during period B who had HR. Patient age, sex, and duration of symptoms (period A, 14.5 +/- 7.8 h; period B, 13.1 +/- 9.9 h) were not statistically significant. Success of HR during period A was 64.5%, and significantly improved for period B at 94.5% (P < 0.01). During period B, 128 of our patients had been referred from elsewhere for failed reduction attempted by radiologists or pediatricians. We were able to perform HR successfully in 118 of these (92.2%). During period A, it was significantly less at 54.0% (P < 0.01). Bowel perforation during HR occurred in two patients during period A (1.4%) and two patients during period B (0.9%), but the latter cases were transferred immediately for emergency surgery with good outcome. Reduction of intussusception by a pediatric surgical team would appear to be significantly safer with better outcome, and is thus more efficient.