Management of intussusception in children: When to observe, when to non-surgically reduce, and when to operate?

Aim:The Sistrunk procedure is the most commonly used technique in the treatment of thyroglossal duct cysts(TDCs). A surgical drain is placed with the concerns of hematoma, edema, and seroma, resulting in airway compromise. There has recently been a general tendency to reduce hospital stay time in many surgical procedures. This study aimed to discuss the feasibility and safety of outpatient Sistrunk procedures without drain. Methods: The hospital records of the patients operated on were retrospectively reviewed by a single surgeon in terms of patients’ demographics, performed operations, and complications. Results: Of 49 patients, 27(55.1%) were boys, and 22(44.9%) were girls. The average age was 6.3±3.7years in the study group (min:13months-max:17years). The most common complaint was swelling in the middle region of the neck. In the patient group, 42 had TDCs and seven had thyroglossal cyst fistulas. Of all TDC cases, 81.6%(n=40), 12.2%(n=6), and 6.2%(n=3) were determined to be localized in the infrahyoid, suprahyoid, and suprasternal regions, respectively. While 15 of our cases were followed up postoperatively (min-max:16-24hours), the other 34 patients were discharged on the same day after the operation (min-max:3-6hours). Whereas the mean hospital stay was 4.7±1.1hours for those discharged on the same day, the time was 18.8±4.3hours for those hospitalized. No complication was observed in the patients undergoing the Sistrunk procedure without drain placement, except for one recurrence. Conclusion: TDCs should be kept in mind in patients presenting with neck swelling. We consider that the drain placement is not mandatory as long as there are no compulsive conditions, such as immune deficiency or coagulopathy, and that meticulous hemostasis during the operation is more significant. Furthermore, the outpatient Sistrunk procedure is safe and well-tolerated for the routine treatment of TDCs. Contact information and specific instructions about the potential complications should also be given to the parents or relatives.