Treatment Strategies for Recurrent Ileocolic Intussusceptions and a Novel Operative Procedure

Background Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75-90% of patients. Recurrent intussusception occurs in 5-16% of all intussusceptions and the treatment strategy is controversial in this patient group. Treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence. We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points. Results We retrospectively reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or 2 failed attempts of UGHR for diagnostic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6 -84) months, and 19 were males and 14 were females. Abdominal pain, agitation and vomiting were common symptoms. UGHR was performed on all 33 patients on at least 2 different occasions. The time between the first and second UGHR treatments was 42.6 ± 186.19 (0-899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on 6 patients. Manual reduction was performed on 5 patients and one was operated by the laparoscopic reduction of intussusception and Meckel’s diverticulum resection. Conclusions Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by ultrasound-guided hydrostatic reduction even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.

Peculiarities of surgical treatment of cervico-mediastinal goiter

Objective. To analyze a surgical tactics and a component of operative interventions, performed for goiter of cervico-mediastinal localization; to formulate the operative technique peculiarities, which give positive effect. Materials and methods. Into the investigation the materials of clinical work in 2005 - 2019 yrs were incorporated of Department of Surgery No 2 of the Second Municipal Clinical Hospital of Poltava City, which constitutes a base of the Department of Surgery No 1 of Ukrainian Medical Stomatological Academy. There were analyzed the results of surgical treatment of 530 patients, suffering various forms of goiter. Results. Basing on data of complex clinic-instrumental and cytological investigations several tactically different operative interventions were performed, the content of which was directly dependent on anatomic peculiarities present. In 155 patients a cervico-mediastinal goiter was present. Conclusion. In big mediastinal goiter a severe operative situation occurs, necessitating nonstandard surgical decisions making. That is why the neck surgical access of the authors own in accordance to Kocher method was proposed. Extrafascial procedures may prevent some iatrogenic complications.