Repeat Enema for Intussusception: Update Course 2016

18 month old, this is my favorite one now. This is my favorite question and then because out of time, we'll, we'll stop it at this 1. 18 month old is into susception. An air enema was done and it moved it to the hepatic flexure. They made progress. Patient's stable. What do you do now? Do you A, laparoscopy, 2, laparotomy, C, repeat the enema. C. She's the. Everybody, God, I do this course for me because I'm still in the dark ages like my entire practice channel, in fact, and I'm gonna defend myself here, I think almost most of the people, Avi, you're hiding behind the TV. You were with me, right? You thought this was crazy, or did you think you would have done a repeat enema? laparoscopy Yeah, there's data to suggest you should do the repeat enema, but it's gonna be radiology and and system dependent because there's a lot of radiologists. There's no way they're gonna try it again. They're gonna say, no, I pushed 120 centimeters pressure. I'm done. So you send them this, Mark, go back to my, uh, let's see, you send them this. This is a quick review that we did, um, they can't, yeah, I know. So we did a review of all the studies that looked at repeat enemas. And he, there were 5 studies, and these were the percentage of success with the repeat enema in those studies, uh, 4 studies there, 4 studies all showed over 50% success. The, the, the mean of them, we're gonna do a meta-analysis. Sophia and Ian are gonna do a meta-analysis, uh, to try to see the actual number, but I might guess it's around 60 to 70% of the time, the contrast enema, so it should be done. That, that is not for us now after we saw when we looked into this, and again I attribute this to the, um. The, the fellows course, the pediatric surgery essential course in in Washington DC where this was discussed that uh this is, this was game changing for me because I always just went to the operating room. I've never done it. The only time I did a repeat enema is if they got to like the appendix. They made it almost the way through. This says if they made any progress in the patient's stable, you must repeat it because more than likely it will be reduced the second time. The question is what's the interval of time between your enemas, and that's the debate. So Tony Sandler's study that was the bottom one there that was uh from Toronto Sick Kids was a 2. They waited 2 to 4 hours. The more recent studies, uh, actually were 6 to 12 hours, basically wait till the next morning. So most of them said wait till because of course it's always at night, wait till the morning and repeat it again. So name is on that first. Oh, that's right. Actually, David was on that. Sorry, David, tell us your thoughts. I guess two points. One, our, our important, important finding to us was that there was not a higher rate of operative resection if you waited and ended up going to the operating room. That's number 1. Number 2, our radiologist said, well, great, does that mean I don't have to come in at 2 in the morning? I can do the first enema at 7:00 a.m. And I think that's a reasonable question. The time interval between, you know, by the time they get to us, it's often in the middle of the night. Undress reduction. So can we wait another 5 or 6 hours to make it nicer? It's probably a question that we should ask. But I think that's what most of them, uh, including your study, most of them were about the mean, except for Tony's, which was 2 to 4, I think your study was, was like 6 hours. It was a long interval between 1st and 2. OK. Any comments about that? Was any, did anyone's management change just now, cause, cause this changed mine. Every, no one, everyone's already doing this. Oh my God, it's so embarrassing. Get the, OK.