Learning curve for laparoscopic reduction of intussusception in children who failed fluoroscopy- guided air enema 

Background: Laparoscopic reduction in the treatment of intussusception in children who failed fluoroscopy-guided air enema has gained popularity recently. The question arises as to how many laparoscopic procedures are required before the technique is safely performed. This study aimed to evaluate and quantify the learning curve associated with laparoscopic reduction for intussusception at the authors’ center. Methods: We performed a retrospective analysis of consecutive patients undergoing laparoscopic reduction by the same surgeon at our center between August 2014 and December 2020. Patient data including age, gender, BMI (body mass index), ASA (American Society of Anesthesiologists fitness grade), clinical manifestation, preoperative air enema attempts, operative time, anatomic type of intussusception, length of intussusception, No. of intussusception, recurrence of intussusception, pathologic lead point, concomitant procedure, complications, conversion, length of postoperative stay were analyzed over time to evaluate the learning curve. Results: A total of 34 patients received laparoscopic reduction of intussusception during the study period. The two groups were comparable, with their baseline demographics and clinical characteristics remained similar over time. Complications were experienced by 27% of the first 15 patients, which decreased to 0% during the next 19 patients (p = 0.029). The median operative time between the first 15 patients (45 min) and the next 19 patients (65 min) was not significantly different (p = 0.822). The median postoperative hospital stay was 4 days for the first 15 patients and 6 days for the next 19 patients (p = 0.253). The conversion rates were not significantly different between the first 15 patients (13%) and next 19 patients (16%) (p = 1.0). Conclusions: The complication rate was sharply decreased after 15 laparoscopic procedures. This indicates that the learning curve for laparoscopic reduction for intussusception of an experienced surgeon is approximately 15 cases.