This journal appraisal compares two techniques for reducing intussusception in children: hydrostatic reduction and pneumatic reduction. A randomized controlled trial of 124 children with intussusception found that hydrostatic reduction had a higher success rate (96.77% vs 83.87%) and lower risk of intestinal perforation compared to pneumatic reduction. However, the recurrence rates were not significantly different between the two groups. The study concludes that ultrasound guidance is useful for both diagnosing intussusception and guiding hydrostatic reductions.
This journal appraisal compares two techniques for reducing intussusception in children: hydrostatic reduction and pneumatic reduction. A randomized controlled trial of 124 children with intussusception found that hydrostatic reduction had a higher success rate (96.77% vs 83.87%) and lower risk of intestinal perforation compared to pneumatic reduction. However, the recurrence rates were not significantly different between the two groups. The study concludes that ultrasound guidance is useful for both diagnosing intussusception and guiding hydrostatic reductions.
This journal appraisal compares two techniques for reducing intussusception in children: hydrostatic reduction and pneumatic reduction. A randomized controlled trial of 124 children with intussusception found that hydrostatic reduction had a higher success rate (96.77% vs 83.87%) and lower risk of intestinal perforation compared to pneumatic reduction. However, the recurrence rates were not significantly different between the two groups. The study concludes that ultrasound guidance is useful for both diagnosing intussusception and guiding hydrostatic reductions.
This journal appraisal compares two techniques for reducing intussusception in children: hydrostatic reduction and pneumatic reduction. A randomized controlled trial of 124 children with intussusception found that hydrostatic reduction had a higher success rate (96.77% vs 83.87%) and lower risk of intestinal perforation compared to pneumatic reduction. However, the recurrence rates were not significantly different between the two groups. The study concludes that ultrasound guidance is useful for both diagnosing intussusception and guiding hydrostatic reductions.
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Journal Appraisal
TEAM H Date of Rotation: April 2-7, 2019 Santos, Christine Tee, John Derrik Vetus, Leah Angela Zamora, Hyacinth Elaine OBJECTIVE: to compare laparoscopic intracorporeal purse-string suture ligation of the hernia defect leaving the sac intact versus disconnection of the hernia sac with intracorporeal suturing of proximal part
• P- Male patients with Congenital Inguinal Hernia
(CIH) aged 8-36 months • I- Purse-string suture ligation of the hernia defect leaving the sac intact • C- Disconnection of the hernia sac with intracorporeal suturing of proximal part • O- Operative time, hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results • M- Prospective controlled randomized study Validity Guides
Were patients randomized? Yes
Was blinding done in the study? No
Were baseline characteristics of the patients in the study groups similar? Yes
Was the follow-up adequate and complete? Yes
Inclusion and Exclusion Inclusion Exclusion • Male patients only • Recurrent cases, • Bilateral CIH complicated cases • Hernia of canal of Nuck in • Unilateral CIH with females questionable other side • Inguinal hernia with • Cases of CIH associated with undescended testis umbilical hernia and • Parental refusal, parental request contraindications for laparoscopy as major lower abdominal surgery 132 patients with CIH Randomization into two equal groups by a random- number table sequence
Group I (N = 66) Group II (N = 66)
Intracorporeal purse string suture Disconnection of the hernia ligation of the hernia sac at IIR sac with intracorporeal suture leaving the sac intact of proximal part at IIR Intervention • Group I (Treatment): Intracorporeal purse- string suture ligation of the hernia defect leaving the sac intact at internal inguinal ring [IIR]. • Group II (Control): Disconnection of the hernia sac with intracorporeal suturing of proxi- mal part at IIR Outcome • There was statistically significant difference in the mean duration for surgery Outcome • There were no statistically significant differences between groups regarding intraoperative complications Outcome • There were statistically significant differences between groups regarding hydrocele formation Outcome • There were statistically significant differences in the recurrence rate between the studied groups • Group I: 2 cases (2.6%) • Group II: none Outcome • All patients have had minimal postoperative discomfort and resumed normal activities later on the same day of surgery. • They passed uneventful postoperative reco and discharged home on the evening of the same day of surgery. Conclusion • Laparoscopic inguinal hernia repair by disconnection of the hernia sac at the IIR with peritoneal closure has lower recurrence rate than the purse string suturing leaving the sac intact. • This method may be safely done. • P-Age of 48months or younger with confirmed diagnosis of HD • I- Probiotic • C- Placebo • O- Incidence of post-operative Hirschsprung- associated enterocolitis • M- Double blinded prospective randomized controlled trial Validity Guides
Were patients randomized? Yes
Was blinding done in the study? Yes
Were baseline characteristics of the patients in the study groups similar? Yes
Was the follow-up adequate and complete? Yes
Inclusion and Exclusion Inclusion Exclusion • diagnosis of HD was • Children 48 months of age confirmed by suction rectal at time of pullthrough, biopsy results prior to hemodynamically unstable, surgical pullthrough active septicemia, major • All patients within 1/2006 congenital anomalies with to 12/2009 suffering from markedly HD at an age of 48months or younger Intervention: Probiotic VSL#3 • Contained 90 billion viable lyophilized bacteria (per packet) composed of four strains of Lactobacillus, three strains of Bifidobacterium, and one strain of Streptococcus salivarius subsp. Thermophilus in a vegetable capsule • Diluted in 2 to 4 oz of expressed human milk or formula • Children ≤5 kg received 90 billion bacteria (one 0.25g sachet/dose) twice a day • Children > 5kg received 180 billion bacteria (two sachets/dose) twice a day • Placebo: identically the same maize starch Outcome • Post-operative visit schedule of 1, 3, 6 and 12months, unanticipated clinic, emergency room or hospital admissions • HAEC was clinically diagnosed and documented by the treating physician • Secondary outcome: number of HAEC episodes, clinical severity of HAEC, and associated contributing factors predisposing to HAEC (e.g., gender, a diagnosis of Trisomy 21, length of aganglionosis, age at diagnosis, and age at pullthrough procedure) Result Results • Overall incidence of HAEC was 28.3% • PLACEBO: – 7/28 (25%) were diagnosed with post-operative HAEC – 6 as clinical grade I – none as grade II – 1 as grade III – 6 (19%) had recurrent episodes of HAEC • PROBIOTIC: – 10/32 (31%) were diagnosed with post-operative HAEC – 3 as clinical grade I – 6 as grade II – 1 as grade III – 6 (21%) had recurrent episodes of HAEC • HAEC was not significantly different between the patients receiving placebo or probiotic therapy (p=0.897) Conclusion • Use of probiotic bacterial therapy was ineffective in reducing either the incidence or severity of post-pullthrough Hirschsprung- associated enterocolitis OBJECTIVE: The aim of this study was to conduct a randomly controlled trial to compare the effectiveness and safety of the hydrostatic and pneumatic reduction techniques.
Were baseline characteristics of the patients in the study groups similar? Yes
Was the follow-up adequate and complete? Yes
Inclusion and Exclusion Inclusion Exclusion • Children from 0 to 18 who • Patients who had were diagnosed with contraindications for a non- intussusception and visited operative reduction the West China of Sichuan (peritonitis, perforation University emergency signs, and non-responsive during the period from shock) January 2014 to December 2015 Methodology • Both techniques of reduction are composed of three repeated 3-min procedures. • Hydrostatic reduction: by a pediatric surgeon using ultrasound guidance (5–10 MHz transducer). All patients received continuous pressure from 74 to 88 mmHg with the assistance of the balloon • Pneumatic reduction: by a radiologist in the company of a pediatric surgeon using fluoroscopic guidance. Fluoroscopic monitoring with a Sonialvision Safire, with pressure from 80 to 120mmHg. • Sedation drugs were given according to the hospital sedation guidelines. Outcome • The primary clinical outcome of the study was the success of nonoperative reduction. – Disappearance of intussusception – Visualization of the normal saline or air from the cecum to the ileum through the ileocecal valve – normal saline or air-distended ileum – disappearance of intussusception after reduction by ultrasound examination. • The secondary clinical outcomes – rate of intestinal perforation during reduction and recurrence after reduction. Result Results Results Results • A total of 147 episodes of intussusception were identified • Median follow-up time was 12 months, however the parents of 12 patients refused to participate in the study • Data of 5 patients is missing. • Six patients were excluded due to the contraindications after the diagnosis. • One hundred and twenty four episodes were included in this study. • The male to female ratio was 2:1. • The median age of the patient was 21.50 months with a mean weight of 12.46 kg. Results • The overall success rate in this study was 90.32%. • Success rate of the hydrostatic reduction (96.77%) was significantly higher than that of pneumatic reduction (83.87%) (p=0.015). • Perforation after reduction was found in only one pneumatic reduction case • The recurrence rate of intussusception in the hydrostatic reduction • (4.84%) was not significantly different compared with pneumatic reduction (3.23%) (p=0.648). Conclusion • The study conclude that ultrasound is useful for the diagnosis of intussusceptions, as well as to guiding hydrostatic reductions by using saline enema. • The study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective non-operative treatment for intussusceptions in the pediatric age group, and should be the first line of management in appropriate patients.
