Background: With the advent of minimally invasive techniques, laparoscopic Ladd's procedure is increasingly used to treat children with malrotation, yet evidence regarding its safety and efficacy is lacking. We hypothesize that operative and postoperative outcomes with the open technique are superior to the laparoscopic Ladd's procedure.
Methods: We conducted a 5-y retrospective chart review of all patients who underwent Ladd's procedure at our institution from 2010-2015. Exclusion of patients included those with concomitant conditions, such as poor gut perfusion, significant reflux, tracheoesophageal fistula, failure to thrive requiring concomitant gastrostomy, and biliary atresia. Kruskal-Wallis and Mann-Whitney tests were used where appropriate.
Results: Between 2010 and 2015, of 130 patients who underwent Ladd's procedure, 77 met inclusion criteria. Sixty-two patients underwent initial open surgery, 15 patients underwent laparoscopy, seven of which were converted to open. Patients undergoing open surgery were younger compared to the laparoscopic groups. Thirty-three of the 77 malrotation patients (43%) presented with volvulus, 27 underwent open surgery, four had laparoscopic converted to open procedures, and two patients underwent laparoscopic Ladd's without incident. Laparoscopy resulted in increased operative time and clinic visits. Patients undergoing laparoscopic to open surgery had longer operative times, time to resume diet, and length of hospital stay. No difference was noted in complications among the groups.
Conclusions: Although minimally invasive approaches are becoming increasingly used, no evidence supports laparoscopic superiority over open Ladd's procedure. We found that open surgery was associated with shorter operating times and fewer clinic visits. Furthermore, laparotomy remains the favored procedure for patients presenting with volvulus.
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http://dx.doi.org/10.1016/j.jss.2018.04.016 | DOI Listing |
Int J Surg Case Rep
January 2025
Department of Infection Prevention and Patient Safety, Eka Kotebe General Hospital, Addis Ababa, Ethiopia.
Introduction And Importance: Intestinal malrotation is a congenital disorder resulting from the failure of the normal embryologic fetal sequence of bowel rotation and fixation. Adult midgut malrotation is extremely uncommon, with incidence estimates ranging from 0.0001 % to 0.
View Article and Find Full Text PDFJ Indian Assoc Pediatr Surg
November 2024
Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Enteric duplication cysts and reversed intestinal rotation (RIR) are rare congenital anomalies, with their coexistence being exceptionally uncommon. We report a 4-year-old girl who presented with chronic anemia and intermittent abdominal symptoms since infancy. Detailed workup for medical causes of anemia was inconclusive.
View Article and Find Full Text PDFAnn Med Surg (Lond)
November 2024
Department of Pediatric Surgery, Palestine Medical Complex (PMC), Ramallah, Palestine.
Introduction And Importance: Biliary atresia is a rare, progressive cholangiopathy that affects newborns, causing jaundice and other manifestations of hyperbilirubinemia. The incidence is higher in Asia than in Europe. The only available treatment is a surgical operation called Kasai portoenterostomy.
View Article and Find Full Text PDFJ Indian Assoc Pediatr Surg
August 2024
Department of Paediatric Surgery, St. George's University Hospital, London, UK.
Need And Purpose Of Review: Approximately 75% of patients with classic malrotation and midgut volvulus present in neonatal age-group; another 15% may present up to one year. In these, the diagnosis is made because of typical presentation. However, there are many cases in which malrotation has been detected after infancy.
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