Abstract
BACKGROUND: After failed ultrasound-guided hydrostatic reduction (USGHR), operative options vary. We evaluated a protocolized laparoscopic-assisted hydrostatic reduction (LAHR) pathway as an escalation strategy. METHODS: This prospective study included 242 children with intussusception treated at a single tertiary center between January 2023 and December 2024. All children received standardized USGHR (≤ 3 attempts in one session). Failures proceeded to LAHR under standardized hydrostatic pressure (80–100 cm H₂O); persistent non-reduction or ischemia/lead point prompted mini-laparotomy and resection. Primary outcome was LAHR success; secondary outcomes included early recurrence (≤ 48 h), complications, time to feeds, and length of stay (LOS). Discharge was milestone-based. RESULTS: Of 242 children, USGHR succeeded in 189 (78.1%); 53 (21.9%) underwent LAHR. LAHR succeeded in 45/53 (84.9%); 8/53 (15.1%) required laparotomy. No intraoperative perforations occurred. Complications after LAHR were low: intraperitoneal infection 1.9%, ileus 3.8%, wound infection 1.9%. Time to enteral feeding was 8.2 ± 1.7 h after uncomplicated LAHR and 47.5 ± 5.8 h with resection. Mean LOS was 1.54 ± 0.36 days after uncomplicated LAHR, 4.25 ± 0.71 days with resection, and 1.95 ± 1.07 days overall. No early (≤ 48 h) recurrences were detected on routine in-hospital surveillance. CONCLUSIONS: A pressure-standardized LAHR pathway is a safe, effective escalation after failed USGHR, achieving high reduction success with low morbidity, rapid feeding, short LOS, and no early recurrences. These reproducible methods offer actionable benchmarks for multicenter comparison; confirmation in larger, comparative cohorts with longer follow-up is warranted. TRIAL REGISTRATION: The Pan African Clinical Trial Registry (pactr.samrc.ac.za) database, PACTR202508726005103, Registration date: 14 August 2025.