Intussusception is the most common cause of intestinal obstruction in infants and young children, particularly between the ages of 6 months and 3 years. It involves telescoping of a proximal segment of bowel into a distal segment, leading to obstruction and potential ischemia. First-line management is typically non-operative, utilizing ultrasound- or fluoroscopy-guided hydrostatic or pneumatic enemas, which boast success rates between 70% and 90% depending on the center and technique used [1,2]. However, when non-operative reduction fails, surgical intervention becomes necessary. Traditionally, laparotomy was the standard approach, but over the past two decades, minimally invasive surgery, particularly laparoscopy, has gained popularity due to its advantages in visualization, reduced postoperative pain, shorter hospital stays, faster return to oral feeding, and improved cosmesis [3,4]. Moreover, laparoscopic-assisted hydrostatic reduction (LAHR) has been developed as a hybrid technique that combines real-time laparoscopic visualization with controlled hydrostatic reduction, enhancing safety and reducing bowel manipulation [5]. Several studies have demonstrated the efficacy and safety of laparoscopy in this setting. Sheng-Miao et al. [6] reported an 87.7% success rate of laparoscopic reduction in a retrospective series of 65 children, with minimal complications and no recurrences. Khairallah et al. [7] found that 75% of laparoscopic attempts were completed successfully after failed enema reductions, with shorter hospital stays and quicker recovery. Laparoscopy also allows assessment of bowel viability and detection of pathological lead points, which may be missed during non-operative reduction. In particular, the laparoscopic approach is especially useful in early-presenting patients without peritonitis, as well as in cases of recurrent intussusception [8]. Furthermore, LAHR has shown promising results even in infants under one year of age, with successful reduction in most cases and a low conversion rate to open surgery [9]. A multicenter review by the French Group of Pediatric Endoscopic Surgery (GECI) demonstrated that laparoscopy had improved outcomes over time, with increased success rates (from 57% to over 90%) and decreased conversion rates (from 43% to less than 10%), suggesting a growing proficiency and better patient selection [10].Overall, laparoscopy—including laparoscopic-assisted hydrostatic techniques—has become an integral part of the management algorithm for pediatric intussusception, particularly after failed enema reduction, offering a safe, effective, and minimally invasive alternative to open surgery. To evaluate the utility of using laparoscopy in assisting Hydrostatic Reduction of Intussusception in Children

Type of Study: The present study was an analytical, observational study with a duration of 18months. Details of 25 consecutive intussusception patients who underwent laparoscopy assisted hydrostatic reduction at the Department of Pediatric Surgery, NRSMCH, Kolkata during January 2023 to June 2024, were retrospectively reviewed. Study recruitment was done after getting informed consent of parents/guardian & accent for children 7-12yrs (prepared in English, Bengali and Hindi) from patients. All study related data were kept confidential. Place of Study: This is a single centre study conducted in the Department of Pediatric Surgery, NRS Medical College and Hospital, Kolkata. Study duration: January 2023 – June 2024(1.5 years) Sample size: 25 consecutive intussusception patients Inclusion criteria: • Children upto the age of 12 years with intussusception. • Patients/parents who are willing/allowed to participate. Exclusion criteria: • Inability to tolerate pneumoperitoneum. • Duration of symptoms more than 48 hrs. • Features of generalized toxicity, high fever, severe dehydration. • Signs of peritonitis. • Radiographic evidence of free peritoneal air. • History of multiple abdominal procedures. Statistical Analysis: For statistical analysis, data were first entered into a Microsoft Excel spreadsheet and subsequently analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Continuous numerical variables were summarized as mean ± standard deviation, while categorical variables were expressed as counts and percentages. The Z-test (Standard Normal Deviate) was employed to assess significant differences between proportions. For comparisons involving means, the student’s t-test was used, with the corresponding p-value obtained from the t-distribution table. A p-value ≤ 0.05 was considered statistically significant, indicating rejection of the null hypothesis in favor of the alternative hypothesis.

Table 1: Demographic, Clinical, Diagnostic, and Operative Details of Intussusception Patients (n=25) Factors Value(n=25) Percentage Gender Male 15 60 Female 10 40 Age 0-6 months 1 4 7-12 months 9 36 >1yr-2yr 12 48 >2yr 3 12 Character of pain Spasmodic 20 80 Continuous 5 20 Vomiting Bilious 17 68 Non bilious 5 20 No vomiting 3 12 Abdominal distension Present 18 72 Absent 7 28 Red stool Present 18 72 Absent 7 28 Diagnosis by X-ray 13 52 USG 25 100 Mental status Alert 18 72 Awake 4 16 Drowsy 3 12 Comatose 0 0 Operative Procedure Laparoscopy 20 80 Converted to open 5 20 Table 2: Age and Gender Distribution of Intussusception Patients (n=25) Age Group Male Female Percentage 0-6 months 1 0 100%Male 0% Female 7-12 months 5 4 56% Male 44% Female >1yr-2yr 8 4 67% Male 33% Female <2yr 14 8 64% Male 36% Female >2yr 1 2 33% Male 67% Female Table 3: Association of Clinical Features with Conversion from Laparoscopy to Open Surgery in Intussusception Patients Lap Converted to Open Laparoscopy Odds Ratio P value Abdominal Distension Present 5 13 6 0.524 Absent 0 7 0.08 Red Currant Jelly Stool Present 4 14 1.7 0.524 Absent 1 6 0.08 Table 4: Association of Mental Status and Wound Infection with Conversion from Laparoscopy to Open Surgery in Intussusception Patients Mental Status Lap Converted to Open Laparoscopy P value Alert 3 15 0.036 Awake 1 3 0.3 Drowsy 1 2 1 Comatose 0 0 0 Wound Infection 0 3 0.032 In this study of 25 pediatric patients with intussusception, 60% were male and 40% were female. The majority of cases (48%) occurred in children aged >1 to 2 years, followed by 36% in the 7–12 months age group. Spasmodic abdominal pain was the predominant symptom (80%), while 68% of patients presented with bilious vomiting. Abdominal distension and red currant jelly stools were each observed in 72% of cases. Diagnosis was confirmed using ultrasonography in all patients (100%), while 52% also had findings on X-ray. Most patients (72%) were alert at presentation, with smaller proportions being awake (16%) or drowsy (12%); none were comatose. Laparoscopic reduction was successfully performed in 80% of cases, while 20% required conversion to open surgery. Among the 25 patients studied, the majority (88%) were under 2 years of age. In the 0–6 months group, there was only one male patient (100%), while the 7–12 months group included 5 males (56%) and 4 females (44%). The >1 to 2 years age group comprised 8 males (67%) and 4 females (33%). Overall, in children under 2 years of age, males accounted for 64% and females for 36%. In contrast, the >2 years age group showed a reverse pattern, with 1 male (33%) and 2 females (67%). Abdominal distension was present in 18 patients, of whom 5 required conversions to open surgery, while 13 underwent successful laparoscopic reduction. None of the patients without abdominal distension (n=7) required conversion. Although the odds ratio for conversion in the presence of abdominal distension was 6, the association was not statistically significant (p = 0.524). Similarly, red currant jelly stools were observed in 18 patients, with 4 requiring conversion and 14 managed laparoscopically. Among the 7 patients without red stool, only 1 required conversion. The odds ratio for conversion in patients with red stool was 1.7, also without statistical significance (p = 0.524). Mental status at presentation showed a statistically significant association with conversion from laparoscopy to open surgery. Among the 18 alert patients, 3 required conversion (p = 0.036), whereas among the 4 awake patients, 1 required conversion (p = 0.3), and among the 3 drowsy patients, 1 was converted (p = 1.0). No patients were comatose. Although conversions occurred across different mental status levels, the statistically significant p-value in alert patients suggests a potential influence of preoperative condition on surgical outcomes. Additionally, wound infections were reported in 3 patients, all of whom underwent laparoscopic procedures and did not require conversion. The association between laparoscopic surgery and wound infection was statistically significant (p = 0.032).

The findings of this study reinforce the evolving role of laparoscopy in the management of pediatric intussusception. With a success rate of 80% and a conversion rate of 20%, laparoscopic-assisted hydrostatic reduction proved to be a reliable and minimally invasive therapeutic option. The observed male predominance (60%) and age distribution, with most cases occurring under 2 years, align with general epidemiological patterns reported in previous pediatric surgical studies [11]. Clinical symptoms such as spasmodic abdominal pain (80%), bilious vomiting (68%), abdominal distension (72%), and red currant jelly stools (72%) remain hallmark presentations of intussusception. These findings support the view that early recognition based on clinical symptoms can improve surgical outcomes. In our study, all cases were successfully diagnosed via ultrasonography, highlighting its continued value as a primary imaging modality, especially in resource-constrained settings where CT or fluoroscopy may not be feasible [12]. Conversion to open surgery occurred in five patients (20%). Abdominal distension and red currant jelly stools were associated with higher odds of conversion (OR = 6 and 1.7, respectively), although these associations were not statistically significant. These findings mirror those of Singh et al. [13], who also observed that these clinical signs often reflect delayed presentation or complicated intussusception but do not always predict failure of laparoscopic reduction. A significant association was found between mental status and conversion to open surgery, particularly in alert patients (p = 0.036). This seemingly paradoxical finding may indicate that even clinically stable patients can have severe pathology necessitating open intervention. Similar trends have been noted by Ahmed et al. [14], who emphasized that intraoperative judgment remains crucial, even in the absence of alarming preoperative signs.Interestingly, wound infection occurred in 3 patients, all of whom had successful laparoscopic reductions. This was statistically significant (p = 0.032) but clinically minor, as none required surgical re-intervention. Comparable minor port-site infections have been reported in other pediatric laparoscopic series [15], likely due to emergency settings or handling of inflamed bowel. Overall, laparoscopic-assisted hydrostatic reduction is a safe and effective technique in the management of pediatric intussusception. Careful patient selection and intraoperative vigilance remain key to optimizing outcomes and minimizing complications.

This study demonstrates that laparoscopic-assisted hydrostatic reduction is a safe, effective, and minimally invasive approach for managing pediatric intussusception, with an 80% success rate and a relatively low conversion rate (20%) to open surgery. The procedure was most effective in younger children under 2 years of age, with early diagnosis via ultrasonography playing a critical role in successful outcomes. While clinical features such as abdominal distension and red currant jelly stools were associated with higher odds of conversion, these were not statistically significant. However, altered mental status, particularly in alert patients, showed a significant association with conversion (p = 0.036), suggesting that underlying severity may not always be clinically apparent. Postoperative wound infections were limited to the laparoscopic group but were minor and self-limiting, despite being statistically significant (p = 0.032). Overall, the outcomes support the role of laparoscopy as a first-line therapeutic option in suitable cases of intussusception, provided careful clinical assessment and surgical readiness for conversion when necessary.

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