Laparoscopic treatment of intussusception

Small bowel obstructions are one of the most common indications for surgical intervention for patients presenting to the Emergency Room in the United States. Causes for small bowel obstruction can be divided into several categories: Extraluminal, Intrinsic, and intraluminal causes. The most common cause for the occurrence of an obstruction is adhesions secondary to prior surgeries. Delayed treatment or non-response of an obstruction to medical therapy could potentially lead to perforation, sepsis and ultimately death. Intussusception, or telescoping of the intestine, is a more rare diagnosis, but the natural history is very similar to small bowel obstruction. Prompt diagnosis and initial empiric therapy are critical in the management of both conditions. Treatment for both of these processes is at first non-surgical, however worsening of the patients clinic horizon will ultimately necessitate surgical intervention. Historically, general surgeons would perform a laparotomy in order to access the bowel for adhesiolysis. In the last several decades with the advent and improvement of laparoscopic methods, there has been a paradigm shift to diagnostic and therapeutic laparoscopy which is now currently preferred by most academic surgeons. Recent literature shows that minimally invasive techniques are becoming the gold standard for most gastrointestinal surgical procedures, citing reduced length of stay and improved pain control with similar rates of success. In this book hapter, we examine the diagnosis, etiology, pathophysiology and treatment modalities for both small bowel obstruction and intussusception of the small bowel, focusing on minimally invasive surgical options. This is a compilation of the most up to date information on diagnosis and management as well as a review of the current literature regarding safety and efficacy of the least invasive surgical techniques.