Minimally invasive versus open surgery for intestinal intussusception in children: a systematic review and meta-analysis

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Abstract

Background. Minimally invasive surgery (MIS) is widely used for pediatric intussusception, yet advantages over open laparotomy across key outcomes remain uncertain.

Aims — compare outcomes of laparoscopic (including laparoscopic-assisted) versus open surgery in children with intussusception.

Methods. PRISMA 2020 systematic review; searches in Medline/PubMed and eLibrary with no language/date limits, plus manual reference screening; last search September 15, 2025; inclusion—comparative clinical studies in patients 0–18 years after failed pneumatic/hydrostatic reduction or when contraindicated; exclusion — non-comparative case series/reports and studies without stratification by approach; risk of bias — RoB 2 (RCTs), ROBINS-I (observational); random-effects meta-analyses (RR, MD, 95% CI); certainty—GRADE.

Results. 7 studies (1 RCT, 6 retrospective), n = 518 (MIS 281, open 237); complications — no difference (RR≈1.0; 95% CI: 0.5–1.9); bowel resection — no difference (RR 0.78; 95% CI: 0.45–1.33); recurrence — no difference (RR 1.29; 95% CI: 0.63–2.64); operative time — no difference (MD 0.8 min; 95% CI: –16.6 to 18.2); length of stay shorter with MIS (MD –1.25 days; 95% CI: –2.46 to –0.04); overall GRADE certainty low/very low. Limitations: predominantly retrospective designs with serious risk of bias, small samples, heterogeneity; protocol not registered (PROSPERO).

Conclusions. MIS shows comparable safety and effectiveness to open surgery and is associated with shorter hospitalization without increasing complications or resections; further RCTs are warranted.

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About the authors

Rayana A. Matsaeva

North Ossetian State Medical Academy

Author for correspondence.
Email: anisa.matsaeva@mail.ru
ORCID iD: 0009-0001-6134-7257

Student

Russian Federation, Vladikavkaz

Khamzat Kh.-A. Bersanov

Pirogov Russian National Research Medical University (Pirogov Medical University)

Email: bersanov.khamzat@mail.ru
ORCID iD: 0009-0001-6750-4639

Student

Russian Federation, Moscow

Ilia A. Smirnov

Bashkir State Medical University

Email: iasmirnov@bashgmu.ru
ORCID iD: 0009-0003-8087-6730
SPIN-code: 8790-8810

Student

Russian Federation, Ufa

Alexey A. Shtykov

Bashkir State Medical University

Email: aleksei_shtykov555666@mail.ru
ORCID iD: 0009-0008-5510-3361

Student

Russian Federation, Ufa

Valeriya I. Gomzina

Bashkir State Medical University

Email: leragomzina6@gmail.com
ORCID iD: 0009-0001-9294-4249

Student

Russian Federation, Ufa

Darya K. Nayanzina

Bashkir State Medical University

Email: daryaa.dolphin@gmail.com
ORCID iD: 0009-0006-0373-5362

Student

Russian Federation, Ufa

Milena I. Oleinik

Bashkir State Medical University

Email: milena-ayupova@mail.ru
ORCID iD: 0009-0003-8267-9992

Student

Russian Federation, Ufa

Ilia S. Sannikov

Bashkir State Medical University

Email: mrilyasannikov@gmail.com
ORCID iD: 0009-0006-7966-3465

Student

Russian Federation, Ufa

References

  1. Wu P, Huang P, Fu Y, et al. Laparoscopic versus Open Reduction of Intussusception in Infants and Children: A Systematic Review and Meta-analysis. Eur J Pediatr Surg. 2022;32(6):469–476. doi: https://doi.org/10.1055/s-0042-1749437
  2. Schwarzer G, Carpenter JR, Rücker G. meta: An R package for meta-analysis. R package version 8.2-1. 2025. Available at:
  3. Kao C, Tseng SH, Chen Y. Laparoscopic reduction of intussusception in children by a single surgeon in comparison with open surgery. Minim Invasive Ther Allied Technol. 2011;20(3):141–145. doi: https://doi.org/10.3109/13645706.2010.518801
  4. Jamshidi M, Rahimi B, Gilani N. Laparoscopic and open surgery methods in managing surgical intussusceptions: a randomized clinical trial of postoperative complications. Asian J Endosc Surg. 2022;15(1):56–62. doi: https://doi.org/10.1111/ases.12965
  5. Hill SJ, Koontz CS, Langness SM, et al. Laparoscopic versus open reduction of intussusception in children: experience over a decade. J Laparoendosc Adv Surg Tech A. 2013;23(2):166–169. doi: https://doi.org/10.1089/lap.2012.0174
  6. Wei CH, Fu YW, Wang NL, et al. Laparoscopy versus open surgery for idiopathic intussusception in children. Surg Endosc. 2015;29(3):668–672. doi: https://doi.org/10.1007/s00464-014-3717-1
  7. Zhao J, Sun J, Li D, et al. Laparoscopic versus open reduction of idiopathic intussusception in children: an updated institutional experience. BMC Pediatr. 2022;22(1):44. doi: https://doi.org/10.1186/s12887-022-03112-9
  8. Sklar CM, Chan E, Nasr A. Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2014;24(7):518–522. doi: https://doi.org/10.1089/lap.2013.0415
  9. Benedict LA, Ha D, Sujka J, et al. The laparoscopic versus open approach for reduction of intussusception in infants and children: an updated institutional experience. J Laparoendosc Adv Surg Tech A. 2018;28(11):1412–1415. doi: https://doi.org/10.1089/lap.2018.0268
  10. Apelt N, Featherstone N, Giuliani S. Laparoscopic treatment of intussusception in children: a systematic review. J Pediatr Surg. 2013;48(8):1789–1793. doi: https://doi.org/10.1016/j.jpedsurg.2013.05.024
  11. Pereyaslov AA, Dvorakevych AO, Nykyforuk OM. Laparoscopy in the treatment of children with intussusception. Galician Medical Journal. 2016;23(3). doi: https://doi.org/10.21802/gmj.2016.3.27

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2. Fig. 1. Flowchart of the literature search conducted according to the PRISMA protocol

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3. Fig. 2. Time to resumption of feeding (days) after laparoscopic (MIS) and open surgery for intussusception in children (mean difference; positive values indicate a longer delay with MIS). The pooled estimate using a fixed-effects model showed a reduction of ~0.35 days with MIS (p < 0.01); however, under a random-effects model the difference was not statistically significant (MD ≈ –0.6 days; 95% CI: –1.47 to +0.31; p = 0.20) due to between-study heterogeneity

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4. Fig. 3. Length of postoperative hospital stay (LOS) after laparoscopic (MIS) and open treatment of intussusception. Mean differences (MIS minus open, in days) are shown for individual studies and pooled estimates. In most studies, MIS was associated with a shorter hospital stay (reflected by negative MD values) [8]. The pooled analysis (random-effects model) indicates an average reduction in LOS of approximately 1.3 days with MIS (MD = –1.25; 95% CI: –2.46 to –0.04; p = 0.04) in the presence of significant statistical heterogeneity (I² = 84.6%)

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