Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan

Naohiro Takamoto; Takaaki Konishi; Michimasa Fujiogi; Mai Kutsukake; Kaori Morita; Yohei Hashimoto; Hiroki Matsui; Kiyohide Fushimi; Hideo Yasunaga; Jun Fujishiro

doi:10.1016/j.jpedsurg.2023.07.004

Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan

J Pediatr Surg. 2023 Nov;58(11):2255-2261. doi: 10.1016/j.jpedsurg.2023.07.004. Epub 2023 Jul 8.

Authors

Affiliations

¹ Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.
⁴ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
⁵ Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: jfujishi-tky@umin.ac.jp.

PMID: 37507337
DOI: 10.1016/j.jpedsurg.2023.07.004

Abstract

Background: Laparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception.

Methods: Patients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs.

Results: The laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35-2.23]), reoperation (1.88 [0.24-14.9]), readmission for intussusception within 30 days (0.80 [0.12-5.30]) and 1 year (0.90 [0.28-2.93]), bowel resection (0.69 [0.46-1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50-1.90]), duration of anesthesia (difference, 11 [-1-24] minutes), postoperative length of stay (difference, -1.9 [-4.2-0.4] days), or total hospitalization costs (difference, 612 [ -746-1970] US dollars) between the groups.

Conclusions: In this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception.

Levels of evidence: Level III.

Keywords: Intussusception; Laparoscopic surgery; Open surgery; Pediatric population.

MeSH terms

Child
Humans
Inpatients
Intussusception* / epidemiology
Intussusception* / etiology
Intussusception* / surgery
Japan / epidemiology
Laparoscopy* / adverse effects
Length of Stay
Meckel Diverticulum* / surgery
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies
Treatment Outcome