Laparoscopic repair of malrotation: what are the indications in neonates and children?

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 25; no. 2; p. 155
• Main Authors: Miyano, Go, Fukuzawa, Hiroaki, Morita, Keiichi, Kaneshiro, Masakatsu, Miyake, Hiromu, Nouso, Hiroshi, Yamoto, Masaya, Fukumoto, Koji, Urushihara, Naoto
• Format: Journal Article
• Language: English
• Published: United States 01-02-2015
• Subjects: Child; Child, Preschool; Digestive System Surgical Procedures - methods; Female; Humans; Infant; Infant, Newborn; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Intestinal Volvulus - complications; Intestinal Volvulus - surgery; Laparoscopy - methods; Laparotomy; Male; Operative Time; Recurrence; Retrospective Studies
• ISSN: 1557-9034
• DOI: 10.1089/lap.2014.0236

To define the role of laparoscopy for treating malrotation in children.
The Ladd procedure (9 laparoscopic [lap-Ladd], 17 open [open-Ladd]; n=26) was performed in children up to and including 30 days of age (neonatal [Group N]) and older (Group C). These groups were compared retrospectively.
Group N (n=14) comprised 3 lap-Ladd and 11 open-Ladd patients. Group C (n=12) comprised 6 lap-Ladd and 6 open-Ladd patients. No case had ischemic bowel preoperatively. Intestinal volvulus was confirmed in 3 of 3 lap-Ladd and 9 of 11 open-Ladd patients in Group N, compared with 5 of 6 lap-Ladd and 6 of 6 open-Ladd patients in Group C (P=not significant). Mean operating times were significantly longer for lap-Ladd patients (130.7 minutes versus 81.1 minutes in Group N and 119.2 minutes versus 74.2 minutes in Group C). Conversion to an open-Ladd procedure was necessary in 1 of 3 patients in Group N and 1 of 6 patients in Group C (P=not significant). Complications arose in open-Ladd patients, bowel obstruction in Group N (1 of 11), and mesenteric chylorrhea in Group C (1 of 6). There was recurrence in 1 of 3 lap-Ladd patients in Group N. Mean time to recommence feeding was earlier for lap-Ladd patients (P=not significant). Length of hospitalization was similar in Group N but was shorter for lap-Ladd patients in Group C (P=not significant).
Although lap-Ladd appears to be a safe procedure, it cannot be recommended for the treatment of malrotation in neonates.