| Multicenter comparison of non-operative techniques of intussusception reduction: saline versus air versus barium |
Soundharya Srinivasan1
, Murali Govindappa Saroja1
, Sandesh Parelkar2
, Beejal Sanghvi2
, Rujuta Shah2
, Chittur Narendra Radhakrishnan3, Ravikiran Cheelenahalli Srinivasa Rao3 |
1Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, India
2Department of Pediatric Surgery, Seth GSMC and KEM Hospital, Mumbai, India
3Department of Pediatric Surgery, Manipal Hospitals, Bangalore, India |
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Received: August 27, 2024; Revised: September 10, 2024 Accepted: September 10, 2024. Published online: October 1, 2024. |
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| ABSTRACT |
Purpose:
Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction.
Methods:
A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction.
Results:
A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality.
Conclusion:
All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability. |
| Key Words:
Enema; Intestinal Obstruction; Intestinal Perforation; Intussusception; Hydrostatic Pressure; Barium Enema |
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