Laparoscopic-assisted hydrostatic reduction of pediatric intussusception: a prospective study from a single tertiary center

TL;DR

A new laparoscopic method successfully treats intussusception in children after initial attempts fail, with low complications and short hospital stays.

Contribution

A protocolized laparoscopic-assisted hydrostatic reduction pathway is introduced as a safe and effective escalation strategy after failed ultrasound-guided reduction.

Findings

LAHR succeeded in 84.9% of cases after failed USGHR with low complication rates.

Time to enteral feeding and length of hospital stay were significantly shorter after successful LAHR.

No early recurrences were observed following LAHR.

Abstract

After failed ultrasound-guided hydrostatic reduction (USGHR), operative options vary. We evaluated a protocolized laparoscopic-assisted hydrostatic reduction (LAHR) pathway as an escalation strategy.

This prospective study included 242 children with intussusception treated at a single tertiary center between January 2023 and December 2024. All children received standardized USGHR (≤ 3 attempts in one session). Failures proceeded to LAHR under standardized hydrostatic pressure (80–100 cm H₂O); persistent non-reduction or ischemia/lead point prompted mini-laparotomy and resection. Primary outcome was LAHR success; secondary outcomes included early recurrence (≤ 48 h), complications, time to feeds, and length of stay (LOS). Discharge was milestone-based.

Of 242 children, USGHR succeeded in 189 (78.1%); 53 (21.9%) underwent LAHR. LAHR succeeded in 45/53 (84.9%); 8/53 (15.1%) required laparotomy. No intraoperative perforations occurred. Complications after LAHR were low: intraperitoneal infection 1.9%, ileus 3.8%, wound infection 1.9%. Time to enteral feeding was 8.2 ± 1.7 h after uncomplicated LAHR and 47.5 ± 5.8 h with resection. Mean LOS was 1.54 ± 0.36 days after uncomplicated LAHR, 4.25 ± 0.71 days with resection, and 1.95 ± 1.07 days overall. No early (≤ 48 h) recurrences were detected on routine in-hospital surveillance.

A pressure-standardized LAHR pathway is a safe, effective escalation after failed USGHR, achieving high reduction success with low morbidity, rapid feeding, short LOS, and no early recurrences. These reproducible methods offer actionable benchmarks for multicenter comparison; confirmation in larger, comparative cohorts with longer follow-up is warranted.

The Pan African Clinical Trial Registry (pactr.samrc.ac.za) database, PACTR202508726005103, Registration date: 14 August 2025.

Figures