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Supplementary text of imaging system, data collection procedures, and additional analysis; and supplementary figures S1 to S13

Intussusception is one of the most common causes of intestinal obstruction in infancy but rarely occurs in the neonatal period. The presentation, pathology and management of neonatal intussusception are quite different from the usual childhood intussusception. Over a 2-year period, we have managed three cases. We herein report our experience to highlight the diversity in presentation and management of neonatal intussusception.

Background Traditionally, total colonic aganglionosis (TCA) was managed with enterostomy +/− pull-through. Since 1998, primary laparoscopic endorectal pull-through (PLEP) was offered to patients with TCA in our unit. A retrospective study was conducted and early results reviewed. Method Patient data were collected retrospectively. Before 1998, enterostomy followed by open Duhamel pull-through was performed. From 1998, patients were assessed to receive staged operation or PLEP. Results From June 1990 to May 2007, 10 patients (6 males) were treated. All presented in the neonatal period. Seven patients, with transition zone within proximal 15 cm of terminal ileum, had pull-through performed. Three had staged pull-through, whereas 4 had PLEP. Two had extensive small bowel involvement with high output stoma pending reconstruction. One had total intestinal aganglionosis and died. The 3 patients with staged pull-through had normal bowel habit without soiling (mean follow-up, 13 years). For PLEP, all procedures were accomplished laparoscopically without intraoperative complication (mean operative time, 6 hours 50 minutes). The mean bowel motion is 5× per day, but most were too young to evaluate continence (mean follow-up, 3.5 years). Conclusion Primary laparoscopic endorectal pull-through is feasible in TCA with limited small bowel involvement and has the advantage of a single-stage operation, avoiding a stoma and its related complications.